
Class, 
Book- 



Copyright )J"_ 






COPYRIGHT DEPOSm 



THE HOME CARE 
OF SICK CHILDREN 



X, 



y 



THE HOME CARE 

OF 

SICK CHILDREN 



A GUIDE FOR MOTHERS IN 
THE CARE OF SICK CHILDREN 



By 

EMELYN LINCOLN COOLIDGE, M.D. 

FORMERLY HOUSE PHYSICIAN OF THE BABIES' HOSPITAL OF THE CITY 

OF NEW YORK; ATTENDING PHYSICIAN IN DISEASES OF CHILDREN 

TO THE SOCIETY OF THE LYING-IN HOSPITAL OF THE CITY 

OF NEW YORK ; AUTHOR OF THE MOTHER'S MANUAL, 

AND FIRST AID IN NURSERY AILMENTS AND 

EDITOR OF THE BABIES' DEPARTMENT 

OF THE LADIES' HOME JOURNAL 



D. APPLETON AND COMPANY 
NEW YORK :: :: LONDON 

19 i6 






COPTEIGHT, 1916, BT 

D. APPLETON AND COMPANY 



JUL -6 1916 



Printed in the United States of America 



)CI,A4336:i5 






^ 



'^Does God fix the death rate? Once men were taught 
so, and death was regarded as an act of Divine Providence^ 
often inscrutable. We are now coming to look upon in- 
fant mortality as evidence of human weakness, ignorance, 
and cupidity. We believe that Providence works through 
human agencies, and that in this field, as in others, we 
reap what we sow — ^no more and no less.^^ 

De. L. Emmett Holt 



INTRODUCTION 



The Health Departments of New York City, 
Chicago, and many other large cities throughout the 
United States, agTee that the chief causes of death 
in infants and young children are diseases of the 
gastro-intestinal tract, respiratory system, and the in- 
fectious diseases. Babies born prematurely and those 
having some defect at birth also make up a large class 
of the early deaths among infants. 

It is thought that if mothers could be made to 
realize how necessary it is to learn about the care of 
babies, the infant mortality would be very much de- 
creased, and much is being done to educate mothers 
in this direction. Many books have been written on 
the prevention of disease and general nursery hygiene, 
and they have done much good, but there are times 
when the baby will become ill although he has the 
best of care, and then the mother must usually be the 
one on whom the chief burden of responsibility falls. 
She must realize just when the child needs a physi- 
cian and must cany out the doctor's orders when he 

vii 



INTRODUCTION 



prescribes the treatment. Often the busy physician 
cannot stop to give object lessons or describe in the 
minute detail needed just how to apply the treatment 
he wishes carried out. It is then that the mother 
feels all at sea ; she is more or less worried and wants 
to do her best but needs a guide to help her. Not 
every family can afford a trained nurse every time 
there is illness in the house. It is with the intention 
of helping and guiding mothers when they must 
nurse their children through the most common ill- 
nesses that occur in nursery days that this little book 
has been written. 

The care of premature and delicate babies, the most 
common diseases of the gastro-intestinal and respira- 
tory tracts, the infectious diseases and a few other 
diseases frequently occurring in childhood have been 
discussed as simply as possible. The usual methods 
of feeding and treating disease in children have been 
considered in detail — all with the idea of assisting the 
mother in her time of greatest need, and helping her 
to intelligently carry out her physician's directions. 
Emelyn Lii^coLisr Coolidqe, M.D. 

New York. 



CONTENTS 

CHAPTER PAGE 

I. General Care and Feeding of Sick Chil- 
dren . 1 

n. Peculiarities of Disease in Children and 

Special Methods of Treatment . . 37 

III. Care of Premature and Delicate Infants 82 

IV. Most Common Diseases of the Organs of 

Digestion ...... 92 

V. Most Common Diseases of the Organs of 

Digestion {Continued) .... 103 

VI. Diseases of Faulty Nutrition and General 

Diseases 143 

VII. Most Common Diseases of the Respiratory 

System 163 

VIII. Diseases of the Nervous System . . 197 

IX. Infectious Diseases of Childhood . .211 

Index 257 



LIST OF ILLUSTRATIONS 

FIG. PAGB 

1. — Glass Graduate 15 

2. — Chapin's Dipper for Removing the Upper Layers 

of Milk . 21 

3. — Clinical Thermometer 40 

4. — Minim Glass . . . . . . .49 

5. — Medicine Glass 50 

6. — Medicine Dropper 50 

7. — Icecap 61 

8. — Rectal Syringe ...... 66 

9.— Nasal Syringe .71 

10. — ^Albolene Atomizer . . . ... 72 

11.— Throat Atomizer . . . . . .73 

12. — Crib Prepared for Steam Inhalation ... 75 

13. — Premature Suit 84 

14.— Breck's Feeding Tube 87 

15. — Shoe to Prevent or Cure Bow-legs in Children . 156 

16.— ^^ Toe-in ^^ Shoe 156 

17. — ^Ankle and Arch Supporting Shoes • ■ . . 156 

18.— "Hand-I-Hold" Mitts . . , ^ . . 206 



THE HOME CARE 
OF SICK CHILDREN 

CHAPTEE I 
GENERAL CARE AND FEEDING OF SICK CHILDREN 

THE SICKROOM 

If the child is to have a long illness, like scarlet fever 
or typhoid fever, or any ailment which is likely to confine 
him to one room for any length of time, great care should 
be taken to see that the room is suitable for him. 

It should be situated at the top of the house, as germs 
fly upward, and it will therefore be much easier to prevent 
others from taking the disease ; it should be on the sunny 
side of the house and large enough to be well ventilated. 
If possible there should be an open fireplace in the room, 
as this greatly aids ventilation and is convenient for burn- 
ing cotton and other small articles which it is not safe 
to take from the sickroom. In winter it is very convenient 
to have some window boards with holes bored into them 
to regulate the air in the room ; in summer there should be 
screens in the windows. 

The child^s bed should be placed so that he does not 

1 



2 ge:n^eral care of sick children 

have to lie and stare at the direct light. Plenty of sun- 
shine should be admitted to the room^ but his eyes should 
be protected from the glare. There should be no carpet 
on the floor; it should be of either hardwood or linoleum 
which can be wiped up daily with a damp cloth. Pictures 
that can be burned at the end of the disease are best if 
the child is able to look at any; the same is true of toys 
— they should be inexpensive and easily washed or de- 
stroyed. Furry animals and such articles should not be 
allowed in the sickroom. 

Growing plants may be allowed but very few cut flow- 
ers^ and these should be removed at night. A screen with 
wash curtains is very convenient^, also a bed table or tray 
on legs. Only the necessary furniture should be allowed., 
and this should include no upholstered pieces. A metal 
bed with comfortable springs and a good hair mattress 
and pillow protected by rubber sheeting and pads should 
be used. A bathroom near at hand will greatly lessen the 
work of taking care of the child. 

The mother should wear a wash dress and keep her 
hair covered by a pretty cap while in the sickroom. If 
the disease is one that can be carried^ she should change 
her dress and cap and carefully wash her face and hands 
before going to another part of the house. Paper bags 
that will hold cotton and gauze used in the sickroom and 
which can be burnt with their contents are very useful to 
have. Laundry that must be washed in another part of 
the house should be carried in covered pails or bags. If 
the disease is a contagious one it should first be soaked in 
a disinfectant. A wet sheet hung at the door of the sick- 
room will help to keep the germs from flying about the 



FUMIGATION AND DISINFECTION 3 

entire house; for this purpose a solution of carbolic acid 
— one part of the acid to twenty parts of water — is usually 
used. This solution may also be used for soaking the pa- 
tients clothes and bed linen and for moistening the cloths 
with which the floor is wiped or the furniture dusted — 
dry dusting should never be allowed in a sickroom. In 
special cases like typhoid fever^ the stools and urine must 
be covered with a disinfectant like the carbolic acid men- 
tioned above before they are thrown down the toilet. 

FUMIGATION AND DISINFECTION 

Fumigation of the Sickroom 

To successfully fumigate a sickroom it must be made 
practically air-tight; all windows should be closed; cot- 
ton batting should be stuffed into the cracks^ or pieces 
of paper pasted over them. The same is true of the doors 
and keyholes. If there is an open fireplace, register, or 
wash basin, with connecting pipes in the room, it must be 
pasted over with large sheets of paper so that none of the 
fumes shall escape through those channels. All bureau 
drawers, closets, and cupboards should be left wide open 
so that they may be thoroughly fumigated. Books which 
must be kept should be hung with the leaves exposed and 
covers open; toys should be destroyed if possible; if not, 
they must be thoroughly fumigated. 

If sulphur is to be used for fumigation sheets dipped in 
water and hung about the room on ropes will help much in 
the thoroughness of the process. Some bricks should be 
placed in the center of the room and on these a small 
tub or deep pan partly full of water, one or two bricks 



4 GENEEAL CAEE OF SICK CHILDEEN 

should be placed in this on which the smaller pan which 
is to contain the sulphur is to stand. The roll sulphur 
should be cracked into small pieces^ and finally some al- 
cohol poured over these. Three pounds of roll sulphur are 
needed for every thousand cubic feet of room space. After 
all is ready the alcohol on the sulphur should be lighted, 
and the final door of the room closed and sealed ; it should 
then be left for twelve to twenty-four hours, then opened 
and aired. The walls, floor, furniture, and everything in 
this room should be washed, either with a cloth saturated 
with bichlorid of mercury, 1-1,000, or with carbolic acid 
1-20. The mattresses and pillows should be sent away 
to be steamed, under pressure if possible; if not, they 
should at least be ripped open to some extent while the 
room is being fumigated. The paper on the walls should 
be scraped off and fresh put on if one can afford it and 
the woodwork repainted. After the thorough washing the 
room should be exposed to sun and air for at least twenty- 
four hours, or better, for several days. Sulphur will ruin 
brass and silver as a rule, and for this reason many prefer 
to use formaldehyd gas. Special apparatus is needed for 
effectual fumigation, and this may be rented from large 
concerns in cities, or these firms will contract for the 
whole process. 

Holt gives the following method of home fumigation 
with formaldehyd: ^Tor each 1,000 cubic feet of space 
there is required 1 lb. of quicklime, 6 oz. of a 40 per cent 
solution of formaldehyd, 2 oz. of a saturated solution of 
aluminum sulphate. The ingredients should be mixed in a 
bucket or bowl which should stand upon wood or in a ves- 
sel containing water, as considerable heat is generated. 



FUMIGATION AND DISINFECTION 5 

The lime is first moistened with water; then the two so- 
lutions previously mixed are poured on and thoroughly 
mixed with the lime by stirring. The liberation of the 
formaldehyd gas takes place very rapidly, practically all 
of it in fifteen or twenty minutes. For a large room 
several receptacles are better than a single large one/^ 

Even after all this is done, bedding, blankets and what- 
ever can be, should be washed or boiled as an additional 
precaution. 

For fumigation after influenza, colds, and the milder in- 
fectious diseases, formalin candles are often used; these 
are convenient, and directions for using them may be ob- 
tained where they are bought. They will not do for cases 
of scarlet fever, smallpox, or where there has been a se- 
rious and prolonged infectious disease. 

Views of the New York Department of Health on Fumi- 
gation IN Private Homes 

For a period of about one year the New York Health 
Department has made experiments pertaining to the value 
of fumigation after the infectious diseases of childhood. 
They have come to the conclusion that very thorough 
scrubbing with soap and water and very thorough airing 
of the entire premises is as useful in preventing the spread 
of these diseases as fumigating had been. Often painting 
and repapering of the house is also advised. Personally, 
I am not yet fully convinced that this method is wise: 
thorough cleaning is always necessary, but in addition it 
seems to me that some fumigation is also required, es- 
pecially following dangerous diseases like scarlet fever and 
diphtheria. 



6 GENEEAL CAEE OF SICK CHILDREN 

Disinfection of the Patient and Nurse 

The patient should receive two baths before he is al- 
lowed to mingle with the rest of the family. He — hair 
and all — should be scrubbed with warm water and soap and 
then washed in a solution of warm bichlorid of mercury, 
1-5,000, or of carbolic acid, 1-50. He should be carried 
into a well-aired room and then dressed in perfectly clean 
clothing. The nurse should take similar baths and pre- 
cautions as to her hair and apparel before mingling with 
the family again. 

THE SICK CHILD'S TOILET 

Strange as it may seem, there are still some persons 
who think a sick child should not be bathed. Many times 
mothers have said to me, ^^1 have not bathed the baby to- 
day, as he seemed too sick.^^ The restless, crying baby, 
uncomfortable in a mass of wrinkled clothing, fully sub- 
stantiates the mother^s statement. While it is often not 
advisable to give a sick baby a tub bath, the sponge bath 
in bed should seldom or never be omitted. 

Unless expressly ordered not to do so by the attending 
physician, the mother or nurse should give every sick 
child a full sponge bath at least once, and generally twice, 
daily. This may be done under cover of a blanket, work- 
ing deftly and quickly so as not to tire the child, and with 
no exposure whatever. The baby should be gently rolled 
from side to side and not lifted if he is very ill ; all parts 
of the body may be reached in this manner. A little alco- 
hol may be added to the tepid water if the child is feverish 



THE SICK CHILD'S TOILET 



or hot, and but little soap should be used and this rinsed 
off with a fresh wash cloth. One arm and one leg should 
be bathed at a time and then gently dried. Patting gently 
with a soft towel is better than rubbing in the process 
of drying the child. 

The eyes should be bathed with clean boiled water or a 
solution of boric acid^ the ears and nose gently cleaned 
with a swab of soft cotton on the end of a wooden tooth- 
pick^ dipped in warm water. If there are hardened secre- 
tions in the nose use a little olive oil on the cotton swab or 
a little liquid albolene. 

The mouth should receive the greatest care. For a 
baby under one year of age a piece of cotton firmly twisted 
on the mother^s little finger should be dipped into boric 
acid solution^ and the entire inside of the mouth gently and 
thoroughly washed at least twice daily. For an older child 
a soft toothbrush will be needed; this may be dipped in 
boric acid solution or equal parts of borolyptol and water, 
or if all the teeth are cut, a powder, such as precipitated 
chalk, may be needed. All the teeth should be carefully 
brushed and the mouth then rinsed with the mild anti- 
septic solution — ^boric acid or borolyptol. If the child 
cannot rinse his mouth, the mother should gently spray it 
with an atomizer. 

The nails of fingers and toes should be kept clean and 
cut when needed. The hair should receive careful atten- 
tion; otherwise it is apt to become matted and be very 
uncomfortable. If too weak to sit up, the child may be 
turned first on one side and then on the other while the 
hair is being brushed and braided. Arranging in two 
braids, so that one will be on either side, is most comfort- 



8 GENERAL CARE OF SICK CHILDREN 

able for children who have enough hair to braid. It should 
be parted in front and brushed off the forehead. Washing 
the hair is a more difficult matter^ but it may be accom- 
plished lying down if necessary. A rubber sheet should 
be spread over the pillow and if the hair is long enough the 
basin of warm soapy water may be held so that the hair 
falls into it^ the scalp may be washed with soap and 
water and then rinsed with a fresh cloth. It should then 
be rubbed T\dth warmed towels; if in summer it may be 
fanned. If the illness is not expected to last more than 
a week or two the hair-washing may be omitted until the 
child is able to be up. 

Rigid cleanliness in all details of the toilet and of the 
crib or bed make all the difference in the world in the 
comfort of the sick child. By quick and deft handling no 
harm whatever is done by a thorough toilet every day. 

CLOTHING FOR THE SICK CHILD 

A child sufficiently sick to be in bed should be clothed 
so that he may be cared for easily and yet be perfectly 
comfortable. For this reason it is usually better to have 
nightdresses which may be slipped over the head or down 
over the feet without handling the child as much as night- 
drawers or pajamas would necessitate. A very sick child 
need not be raised at all while his clothing is being changed 
if the shirt opens all the way down the front and night- 
dresses are worn. For an older boy nightshirts are best. 
In cool weather the band;, shirt and nightdress should be 
of medium-weight wool, mixed with silk or cotton. The 
band will be needed until the child is three years old; a 



CLOTHING FOR THE SICK CHILD 9 

child over two years of age may wear the band and flannel 
nightdress or a heavy Canton or outing flannel nightdress 
and omit the shirt while he is in bed; when he is able to 
sit up a flannel sack should be put on. The kimono sacks 
and wrappers are in favor because of the loose sleeves, but 
these often let in a great deal of air and cause the mother 
to wonder why the child^s hands are so cold. I prefer a 
snugly fitting sack of knitted wool like a sweater, that 
opens all the way down the front and is light in weight 
but warm. If the wrists are well protected the hands are 
more apt to remain warm. 

Long woolen stockings should be kept on the child^s legs 
if the weather is cool — cold feet often prevent sleep. A 
baby under two years of age may wear the long envelope 
nightdresses which have a flap which turns up at the 
bottom, buttoning over like an envelope. They may be 
easily pushed up to change or even to sponge the 
child when it is considered best not to move him about 
much. 

In summer it is necessary to take all possible care to 
keep the child cool while in bed. A thin lawn or muslin 
nightdress with a very thin silk and wool band are usually 
all the clothing needed besides the diaper, for a baby 
under two years old. No matter how warm it is the abdo- 
men of a young child must be kept at a uniform tempera- 
ture as much as possible^ for here lies the key to a good 
digestion. 

When the child is able to be up part of the day, little 
knit or felt bedroom slippers and a warm wrapper in win- 
ter or a lawn one in summer will be needed in addition 
to the underwear usually worn. 



10 GENERAL CARE OF SICK CHILDREN 

AMUSEMENTS FOR THE SICK CHILD 

While it is always best to let a well child amuse himself, 
it is often advisable to entertain a sick or convalescent 
child for a short time daily. This does not mean, how- 
ever, that he should be humored and spoiled into ex- 
acting entertainment from those who have the care of 
him; it should be done rather as a reward for good be- 
havior. 

One thing at a time and everything else put out of 
sight, is the best plan to follow in amusing a sick child; 
in this way he does not grow tired or confused and the 
toys preserve their freshness and attractiveness. Woolly 
animals or ones with fur collect dust and germs; paper 
toys that may be burned with no considerable loss, wooden 
and rubber articles that may be washed off, are by far 
the best articles to have in the sickroom. Of course a 
little girl may have her dolls, but they should not be too 
valuable to be destroyed later if the disease be a contagious 
one. 

The making of paper flowers is a pleasant occupation 
for sick children over five years of age; younger children 
will like dolls, animals and little toy villages cut out for 
them, or they may like to assist, using a pair of blunt 
scissors. A fox hunt is usually much enjoyed. The 
hounds, fox, and horses, with their riders, the fences 
over which they jump, may all be cut out of stiff paper and' 
set up in little grooved pieces of wood on the bed table. 
If done a little at a time this game will cover several 
days. 

Scrapbooks and doUhouses made in a blank book by 



AMUSEMENTS FOR THE SICK CHILD 11 

cutting out different articles from old magazines and fur- 
nishing each room of the paperdolFs house, is also a fine 
amusement and one that may be made to last weeks at a 
time. 

The picture stamps that are now so popular will also be 
much admired by the little sick child. This is easy work 
and the child may be given a moist paint brush to wet 
the back of the stamps and paste them in the little albums 
arranged for this purpose. 

Transparent slates, crayons and paint boxes, as well as 
many kindergarten gifts and occupations are all helpful 
in whiling away the tedious hours for the convalescent 
child. 

A little sick boy whom I knew was made very happy 
by a ^^surprise box.^^ In this pasteboard box little inex- 
pensive presents — five or ten cents — were wrapped in 
bright tissue paper and tied with bright ribbons. Each 
package was marked with the date on which it was to be 
opened, one present for each day of the time he was 
confined to his room. It proved to be something to look 
forward to and helped to make time pass very pleas- 
antly. 

Eeading to sick children is also a very pleasant occupa- 
tion, but it should not be continued too long at a time, 
as the child^s brain may tire, in spite of his urgent ap- 
peal for more. 

A bed rest on which pillows may be placed saves the 
child^s strength very much when starting to sit up after a 
long illness. If there is none in the house a little nursery 
chair may be used; it should be turned upside down, the 
pillows resting against the back of it. This makes a com- 



12 GENERAL CARE OF SICK CHILDREN 

fortable inclined support for the little back of the child 
as he partially sits np in bed. 

DISCIPLINE OF THE SICK CHILD 

If the child has been taught to obey when well^ the 
mother or nurse will have very little trouble with him 
when ill. Because he is sick the child should never be 
humored or overindulged; very gently but firmly should 
he be managed. The child will take very kindly to his 
bed if he is handled in the right way and not made to 
feel it a great hardship to stay there. 

Do not tell the child what is not true — if you do he 
will never trust you again. Never frighten him with 
threats of the doctor ; he should be taught that the doctor 
is his best friend when he is ill and means only to help 
him get well. 

Children who have been well brought up and obey easily 
get well much more rapidly than those who rebel at every- 
thing done for them. Constant fighting to get things done 
will exhaust the child and send up the temperature. 

THE FEEDING OF SICK CHILDREN 

In preparing food for the sick child the greatest care 
must be observed. Food that is intended to be served warm 
must be really warm and not cool^, while food that is or- 
dered cold must be very cold and not lukewarm. By 
the use of a hot-water plate the food may be kept warm 
while it is being eaten. A nursery ice box kept near the 
sickroom upstairs will save many steps and be very useful 



THE FEEDING OF SICK CHILDEEN 13 

in keeping Vichy^ milk^ etc., at the required temperature. 
A small nursery ice cream freezer that will make half a 
pint of ice cream will be found valuable. If the child is 
having a long illness a pretty little set of china for his 
exclusive use will be much appreciated. The sick child's 
meals should be served very daintily, for it is permissible 
io coax a sick child, when a well child should not be coaxed 
or bribed in any manner, but made to obey because it is 
best. 

A bed table for the meals, and later on for toys, will be 
found very useful. 

Food for each special disease will of course be ordered 
hy the attending physician, but a few recipes that are 
used in many diseases may well be given here. For more 
detailed recipes, the book called ^^Practical Dietetics^^ with 
reference to diet in disease, by Alida Frances Pattee, will 
be found very helpful. 

The table on page 14 may also be used as a guide for 
feeding breast-fed babies. 

There is no real ^^average'^ baby. Babies differ when 
sick as much as when well. The age limits given here for 
strength of food, intervals of feeding and quantities at 
each meal are only approximate. Each child must be 
closely watched and studied, his food being increased or 
decreased according to his special needs. 

Whenever possible, the mother should place her baby un- 
der the care of a good physician and let him guide the 
feeding, but when this is not possible, the methods given 
here may be tried. They have been highly successful 
with thousands of babies. 



14 GENERAL CARE OF SICK CHILDREN 

Intervals of Feeding and Quantities Allowed for Babie& 
During the First Year 



Age 


Number 
of meals 

during day. 

6 or 7 A.M. 
to 

9 or 10 P.M. 


Interval 

between 

meals 

by day 


Number 

of night 

meals. 

9 or 10 P.M. 
to 

6 or 7 A.M. 


Amount 

of one 

meal 


Amount 
for 24 
hours 


First 
Month 


8 


2 
hours 


2 
meals 


1^3 
ounces 


15-30 
ounces 


2nd 
Month 


7 


2>^-3 
hours 


1 
meal 


2)^ 
ounces 


20-32 
ounces 


3d and 4th 
Month 


6 


3 
hours 


1 

meal 


3^-5 
ounces 


243^35 
ounces 


5th and 6th 
Month 


6 


3 

hours 





4--6 
ounces 


24-36 
ounces 


7th, 8th, 9th 
Month 


6 


3 

hours 





6-7 
ounces 


36-42 
ounces 


10th, nth, 12th 
Month 


5 


3J^ 
hours 





6-8 
ounces 


30-40 
ounces 



DIRECTIONS FOR PREPARING THE FOOD 

All utensils for preparing a baby^s food should be kept 
separate from other household articles of this kind; even 
the towels used in wiping the baby^s dishes should be kept 
for this use exclusively. 

It will help much if a regular glass graduate is used to 
measure the ingredients; nursing bottles with ounces 
marked on them are apt to vary considerably. A clean 



DIEECTIONS FOE PREPARmO THE FOOD 15 

pitcher, several spoons, a glass funnel, a double boiler 
and a little cream dipper, to measure the top milk if this 
is to be used, or to measure sugar in either set of formulas, 
are needed. The usual cream dipper holds just one ounce 
of fluid. If impossible to measure in articles holding just 
an ounce, then two tablespoonfuls may be counted as one 




Fig. 1. — Glass Graduate. (Courtesy of WhitaU Tatum Co., 
New York.) 

ounce of fluid, but this is not nearly so accurate. Two 
scant dipperfuls of milk sugar may be considered as one 
ounce or three even tablespoonfuls. 

The quality of milk to be given to the baby is of great 
importance. It should come from a herd of tuberculin- 
tested cows — mixed grade cows are best. Milk from fancy 
breeds or Jersey cows is seldom used with success in feeding 
babies; it is apt to contain too much fat. Milk that is 
produced under the supervision of a medical board should 
be used if it can be obtained. This is called ''certified 
miW and contains only a certain number of bacteria, 
whereas ordinary milk may contain so many baccilli that 
it is really unfit for a baby's use. It is very seldom neces- 



16 GENEEAL CARE OF SICK CHILDREN 

sary to pasteurize certified milk, and for this reason alone 
it is much to be desired. Raw, clean milk is best for 
babies. 

The milk should be kept in the original glass bottles in 
which it is brought to the house and on ice until it is 
time to prepare the food for the day; it should then be 
poured into a sterilized pitcher and well mixed, if the 
whole milk formulas are to be used. The entire quantity 
of food needed for twenty-four hours should be prepared at 
one time, the amount for each meal should be poured into 
a nursing bottle, having as many bottles as there are meals 
in twenty-four hours. The barley water or other cereal 
water or boiled water should be prepared first and the 
quantity needed for the special formula should be meas- 
ured; then the given amount of sugar should be dissolved 
in this hot gruel or water and well stirred and strained. 
This should then be cooled to about 98° F. or lukewarm; 
then the milk and lime water should be well stirred in, the 
food bottled and tightly corked with clean cotton stoppers, 
and the bottles placed in a wire rack in a deep pan of 
cold water until the food is thoroughly and quichly chilled. 
They should then be placed beside the ice until required 
for a meal, when the bottle needed for that meal may be 
warmed by standing it in hot water until the food is 
98° F. The temperature will easily be ascertained by 
dropping a little of the food on the pulse at the wrist. It 
should feel just lukewarm. If the baby can have a small 
ice box for his own use it will be much better than keep- 
ing his milk in the household refrigerator. If it is not 
possible to obtain ice, the food may be kept in a cold room 
if it can be kept below 50° F. 



THE CAEE OF BOTTLES AND NIPPLES 17 

All bottles and devices intended to keep a baby's food 
warm^ as for a night feeding, etc., are positively harmful 
and must never be used. Bacteria multiply rapidly in 
warm milk and grave disturbances of digestion thus arise. 

THE CARE OF BOTTLES AND NIPPLES 

Plain round bottles vrith ounces marked on them are 
best; it is always well to have one dozen bottles in the 
house. If any of the baby's food is left at a meal it must 
be thrown away— never should it be warmed up for an- 
other meal. 

The bottle should be rinsed in cold water as soon as the 
child has finished feeding. It should then be filled with 
cold water and a pinch of bicarbonate of soda or borax 
added. It may stand until the whole number for twenty- 
four hours has accu.mulated ; they can then be attended 
to at the same time. Just before making up the food 
for the day the bottles should be thoroughly washed in 
hot water and soapsuds and cleaned inside with a bottle 
brush, then carefully rinsed with cold water and boiled 
for twenty minutes. They are now ready to fill with the 
new day's supply of food. If it is necessary to leave them 
a few minutes before filling with the food they should 
be placed on wooden pegs, neck^ or mouth, downward and 
covered with a clean towel. 

The rubber nipples also require great care. Plain black 
rubber nipples having one small hole are the best kind. 
Non-collapsible nipples are very difficult to find. Nipples 
having any device on the inside that will collect germs 
should not be used, nor should lonsr rubber tubes attached 



18 GENERAL CARE OF SICK CHILDREN 

to the nipples and put into the bottles; it is not possible 
to keep these clean enough. As soon as the baby finishes 
a meal the nipple should at once be rinsed with cold water 
and placed in a covered cnp containing boric acid solution 
(one teaspoonful of the boric acid to one pint of boiled 
water) or into boiled water containing a pinch of borax. 
New nipples should be boiled for five minutes, but it is 
not best to repeat this daily, as it softens the rubber. 
Once daily all the nipples should be turned inside out 
and scrubbed with a brush in hot water and soapsuds; 
they should then be rinsed in cold water and returned 
to a cup of freshly prepared boric acid or borax water 
and covered. 

The hole in the nipple should never be large enough to 
allow the food to run through it in a stream ; it should be 
just large enough to permit it to drop rapidly through it 
when the bottle is inverted. If one cannot obtain nipples 
with a hole small enough, then blind nipples should be 
bought and the holes put in at home by heating a cambric 
needle and burning the correct sized hole in the nipple. 
Several nipples should be used daily, but it is not neces- 
sary to have a fresh one for each meal. 

FOOD FORMULAS FOR BOTTLE-FED BABIES 
Whole Milk Mixtures 

For babies who do not digest fat or cream well the 
whole milk formulas are usually best; when these are 
used it is generally better to use a cereal gruel as tht? 
diluent in place of boiled water. This helps to soften 



FOOD FOEMULAS FOE BOTTLE-FED BABIES 19 

the curd in the milk as well as add nourishment to the 
food. 

A baby with weak digestion or any acute illness will 
have to be given a weaker formula than the average baby 
for a given age. Therefore^ it may help the mother to 
know what the so-called ^^^average'^ healthy baby is usually 
able to digest in order that she may better judge about 
weakening the food for the sick baby. The following 
formulas are those which often agree with a baby in nor- 
mal health of a given age. 

Malt sugar^ milk sugar or cane sugar may be used^, ac- 
cording to the digestion of the child. It has been thought 
that malt sugar ferments less easily and is more readily 
absorbed than milk or cane sugar ; this is no doubt true in 
the case of many infants^ but others do just as well or 
even better on milk or cane sugar. The same is true about 
using lime water or bicarbonate of soda as the antacid in 
the formulas. To some babies lime water is constipating 
while to others it is not so; if it is found constipating it 
may be omitted from the formulas and one-quarter of a tea- 
spoonful of bicarbonate of soda used for the twenty-four 
hours supply of food, the required amount of diluent 
being made up by adding the same amount of gruel for the 
lime water which is subtracted from the formulas. If 
the child is very much constipated it may be necessary 
to use from one to two teaspoonfuls of milk of magnesia 
in the formulas as the antacid {see page 133). 

Goat^s milk has been tried by some as a substitute for 
coVs milk. Personally I have not found it helpful in 
feeding babies. If it has to be used, however, it may be 
diluted very much, as in the case of cow^s milk. 



20 



GENERAL CARE OF SICK CHILDREN 



Whole or Plain Milk Formulas 



First Month 



Oz. 



Second Month 



Cow's milk 6 

Barley water 23 

Lime water 1 

Milk or malt sugar 1}4 

Or else cane sugar J^ 



Third and Fourth Months 
Oz. 

Cow's milk 15 

Barley water 20 

Lime water 1 

Milk or malt sugar IJ/2 

Or else cane sugar 3^ 



Seventh, Eighth and Ninth Months 

Oz. 

Cow's milk 26 

Barley water 15 

Lime water 1 

Milk or malt sugar 13^ 

Or else cane sugar 3^ 



Oz. 



Cow's milk 10 

Barley water 21 

Lime water 1 

Milk or malt sugar 1 

Or else cane sugar J^ 

Fifth and Sixth Months 

Oz. 

Cow's milk 18 

Barley water 17 

Lime water 1 

Milk or malt sugar 1 }^ 

Or else cane sugar 3^ 

Tenthy Eleventh and Twelfth Months 

Oz. 

Cow's milk 32 

Barley water. 7 

Lime water 1 

Milk or malt sugar 1 

Or else cane sugar 34 



For quantities and intervals of feeding, see Table, page 
14. 

Any one of the cereal gruels may be substituted for the 
barley water in these formulas (see page 25), oatmeal 
gruel often being used to relieve a tendency to constipa- 
tion. Rice water may be well borne if there is slight starch 
indigestion when trying barley or wheat gruel. 

If impossible for a baby to digest gruels, plain boiled 
water may be used as the diluent. 

When the baby is in his twelfth month less and less of 
the diluent should be used until whole, undiluted milk is 
reached, the lime water and sugar being gradually de- 
creased also. 



FOOD F ORMULAS FOE BOTTLE-FED BABIES 21 

Top Milk Mixtures 

Premature babies and babies who cannot digest the curd 
of milk do better on what is known as 'Hop milk mixtures/' 
It is seldom thought best nowadays to use a richer milk 
than is obtained from dipping off the top half from a 
quart bottle of average certified milk. 




Fig. 2. — Chapin's Dipper for Removing the Upper Layers of 
Milk. (After Holt's ^'Diseases of Infancy and Childhood.") 



A small dipper may be obtained for removing the top of 
the quart bottle of milk. The entire sixteen ounces should 
be dipped off unless otherwise ordered by the doctor, and 
the required amount of milk in the formulas taken from 
this top sixteen ounces^ or dipperfuls, which have been 
removed. Never make the mistake of taking off from the 
top of the bottle of milk only just enough milk to be 
3 



22 GENERAL CARE OF SICK CHILDREN 

used in the formulas because if this is done it will give 
an entirely different percentage of fat in the mixture. 
For example if the formula calls for six ounces of top 
milk^ do not take off only these six ounces, but remove the 
entire sixteen ounces of top milk and then take the six 
ounces required in the formula from this. 

When the top milk mixtures are used it is often best to 
use boiled water for the diluent until the baby is at least 
three or four months old. This may be done much longer 
if the baby has starch indigestion. Here again each case 
differs and must be prescribed for by the doctor in charge. 
It is also correct to use any one of the different kinds 
of sugars with the top milk formulas and any one of 
the antacids, but as the top milk mixtures are apt to be a 
little more laxative in their nature than the whole milk 
mixtures it is generally found best to use lime water 
with these formulas rather than bicarbonate of soda or 
milk of magnesia. 

Top MilJc Formulas. 

First Month. — With a spoon or tiny dipper remove the top 
sixteen ounces from a quart of bottled milk. Take six ounces 
of this top milk, add to it one ounce of lime water, twenty-three 
ounces of boiled water, in which one and one-half ounces of milk 
sugar have been dissolved, and mix all thoroughly. Pour two 
ounces of this mixture into each one of ten feeding-bottles and 
cork tightly with clean cotton. 

By the time baby is three weeks old three ounces of this 
formula may be given and seven ounces of milk used in the 
formula instead of six. 

Feed baby every two hours from six a.m. to ten p.m., but 
only once during the night between these hours. 

Premature babies may be able to take only four ounces of 



FOOD FOKMULAS FOE EOTTLE-FED BABIES 23 

the top sixteen ounces, in place of the six ounces mentioned for 
this age. They need feeding more frequently and less at a time 
{see page 88). 

Second Month, — Remove the top sixteen ounces from a quart- 
bottle of milk, using a small dipper for this purpose. 

Take nine ounces of this top milk, add to it one ounce of 
lime water, twenty ounces of boiled water, in which one and 
one-half ounces of milk sugar have been dissolved, and mix 
well; pour three ounces of this mixture into each one of eight 
bottles. 

The baby should be fed every two hours and a half from six 
A.M. to nine p.m.; then only once during the night between 
these hours. 

When baby is six weeks old, if he seems hungry and is digest- 
ing the food perfectly two more ounces of milk may be added 
to the formula (making eleven ounces in place of nine) and four 
ounces given at each meal in place of three. 

Third Month. — With a small dipper remove the top sixteen 
ounces from a quart-bottle of milk. Take thirteen ounces of 
this top milk, add to it one and one-half ounces of lime water, 
twenty and one-half ounces of boiled water in which one and 
one-half ounces of milk sugar have been dissolved, and mix 
well; pour four ounces of this mixture into each one of seven 
bottles. 

The baby should now be fed every three hours from six a.m. 
until nine p.m. and once during the night between these hours. 

When baby is ten weeks old, if the food is being digested well 
one more ounce of milk may be added to the formula (making 
fourteen ounces in place of thirteen) and four ounces and a half 
may be given at each meal. 

Fourth Month. — With a small dipper remove the top sixteen 
ounces from a quart-bottle of milk, take fifteen ounces of this 
top milk, add to it two ounces of lime water, nineteen ounces of 
boiled water in which one and one-half ounces of milk sugar 
have been dissolved, and mix well ; pour four and one-half ounces 
of this mixture into each one of six bottles. 

The baby should be fed every three hours from six a.m. until 



24 GENEEAL CARE OF SICK CHILDREN 

six p. M., then at ten p. m. and not again until six the next morn- 
ing. 

When baby is fourteen weeks old, if the food is being digested 
well five ounces may be given at each meal in place of four and 
a half. 

Fifth Month. — With a small dipper remove the top sixteen 
ounces from a quart-bottle of milk, take the entire sixteen 
ounces of this top milk and add to it two ounces of lime water, 
18 ounces of boiled water or barley water in which one and one- 
half ounces of milk sugar have been dissolved, mix well, and 
pour five ounces of this mixture into each one of six bottles. 

The baby should be fed every three hours from six a. m. until 
six P.M.; then at ten p.m., and not again until six the next 
morning. At the eighteenth week five ounces and a half may 
be given at each meal. 

Sixth Month. — Remove with a tiny dipper eighteen ounces 
from the top of a quart-bottle of milk; add to this two ounces 
of lime water, sixteen ounces of boiled water or barley water in 
which one and one-half ounces of milk sugar have been dissolved ; 
mix well and pour five and one-half ounces of this mixture into 
each one of six bottles. 

The baby should be fed every three hours from six a. m. until 
six p.m., then at ten p.m., and not again until six the next morn- 
ing. 

If the food is being well digested and the baby seems hungry 
he may be given six ounces at each meal when he is twenty-two 
weeks old. 

Seventh Month. — ^With a small dipper remove the top twenty- 
four ounces from one quart-bottle of milk, add to this two 
ounces of lime water, sixteen ounces of boiled water or barley 
water in which one and one-half ounces of milk sugar have been 
dissolved, and pour six ounces of this mixture into each one of 
six bottles. 

The baby should be fed every three hours from six a.m. until 
six P.M., then at ten p.m. and not again until the next morn- 
ing. 

Six ounces and a half may be given at each meal if the food 



EECIPES FOE FOOD 



is being well digested by the time the baby is twenty-six weeks 
old. 

Eighth Month. — With a small dipper remove the top twenty- 
six ounces from a quart of bottled milk, add to this two ounces 
of lime water, sixteen ounces of boiled water or barley water in 
which are dissolved one and one-half ounces of milk sugar, and 
pour six and one-half ounces of this mixture into each one of 
six bottles. 

The baby should be fed every three hours from six a.m. to 
six p. M., then at ten p. m. and not again until the next morn- 
ing. 

Seven ounces may be given at each meal if the food is being 
well digested, by the time the baby is thirty weeks old. 

From this time on the baby should take whole or plain 
milk mixtures (see page 20). 

If the attending physician thinks best, and the baby 
shows a peculiarity in not being able to digest proteins, 
the top sixteen ounces from each one of two quart-bottles 
of milk may be removed and mixed before the required 
amount in each formula is taken, when it is time to give 
the formula for the sixth month, and thereafter; this is 
very seldom necessary, however. It is usually better at 
that age to add more protein, little by little, by taking 
milk lower down in the bottle until the whole milk formu- 
las are reached. 

RECIPES FOR FOOD 

Barley and Oatmeal Gruels or Waters from the Flour. — 
Take one teaspoonful of barley flour,* or two of oatmeal 
flour, and mix into a smooth paste with a little cold water ; 

*The cereal or "Cereo" flours may be obtained from Cereo 
Co., Tappan, New York. 



26 GENEEAL CARE OF SICK CHILDREN 

now stir this into one pint of boiling water and boil for 
fifteen minutes; add a pinch of salt and enough water 
to make up the pint (for some will have boiled away) ; 
then strain. 

If the flours cannot be obtained use the grains. Take 
two tablespoonfuls of barley or three of oatmeal grain; 
soak in cold water over night; the next morning pour off 
this water and add one quart of fresh water and a pinch 
of salt;, and boil steadily for four hours down to one pint, 
adding water as it boils away so that a pint will be ob- 
tained at the end of the time ; then strain through muslin 
or a fine sieve. Gruels must be made fresh every day. 

Rice water, arrowroot, and wheat water are made in 
the same way as the oatmeal gruel, only rice or wheat 
flours are taken in place of the oatmeal. 

Cereal Jellies, — Barley, oat, rice, arrowroot, and wheat 
jellies are made as above also, but one tablespoonful of the 
flours is taken to six or eight ounces of water and boiled 
to the consistency of a jelly. 

Farina Gruel. — One tablespoonful of farina should be 
mixed with one tablespoonful of cold water; then added 
to one cup of boiling water, stirring so it will not lump, 
and boiling thirty minutes; then add one cup of milk 
scalded, and a pinch of salt. To vary this a beaten egg 
may be added and the whole mixture then well beaten. 

Dextrinized Gruels. — Three tablespoonfuls of barley, 
wheat or oat flours, one pint of water; boil twenty min- 
utes. Add water to make up the pint when finished. 
When this is lukewarm (100° F.) add one teaspoonful of 
Cereo, stir well and strain. The Cereo changes the starch 
to dextrinized maltose. 



EECIPES FOR FOOD 27 

This is often used to dilute milk in place of the plain 
gruels, or sometimes it is used alone. Less sugar is needed 
in the formulas when dextrinized gruels are used — gen- 
erally about one-half the usual amount of sugar and some- 
times even less. Babies who have starch indigestion are 
sometimes able to take gruels made in this manner. 

Flour Ball. — One-quarter of a pound of wheat flour 
should be tied in a thick cloth and boiled in one quart of 
water for three hours. The cloth should then be removed 
and the flour exposed to the air, or it may be heated until 
hard. One tablespoonful of this flour ball grated may be 
put into half a pint of fresh milk and stirred over the 
fire until it comes to a boil, a pinch of salt and one table- 
spoonful of cold water should then be added. It should 
be served hot. It is often used for summer complaint, 
when milk may gradually be resumed. 

Pasteurized Milk. — A regular pasteurizer may be bought 
for four dollars, but if one does not care to go to this ex- 
pense the bottles of modified milk may be placed in a pot 
of cold water, which is then rapidly brought to the boiling 
point; the pot is then removed from the stove and the 
bottles allowed to remain in it for twenty minutes, when 
they are taken out and cooled as quickly as possible by 
allowing first warm and then cold water to run over the 
outside of the bottles. When quite cold they should be 
placed on ice until mealtime, when they may be heated 
as usual. If ^^Certified Milk'^ can be obtained it is rarely 
necessary to pasteurize it, even in summer. 

Peptonized Milk. — One pint of fresh milk, five grains 
of the extract of pancreatis, fifteen grains of bicarbonate 
of soda. Eub the pancreatis and soda up in a tablespoon- 



28 GENERAL CARE OF SICK CHILDREN 

ful of the milk^ then add it to the rest of the milk and 
shake well; place it in a glass jar and stand the jar in a 
pitcher of water, 110^ F. ; keep it at this temperature for 
two hours if the milk is to be completely peptonized, or as 
long as the doctor may direct. If only partially peptonized 
the milk should be scalded at the end of the given time. 

Whey. — One quart of fresh milk, two teaspoonfuls of 
sugar, a pinch of salt, four teaspoonfuls of essence of pep- 
sin or liquid rennet. When the milk is just lukewarm add 
the other ingredients, stir for a minute, then allow it to 
stand for about twenty minutes ; break up the clot with a 
fork and strain the whey through muslin; if ordered, a 
little stimulant may be added to this. 

Buttermilk. — This is often useful for babies who cannot 
digest the fat in cow^s milk. In severe cases of chronic 
indigestion and in some cases of acute indigestion it is 
now frequently employed. Older children who are apt to 
have ^T)ilious attacks^^ do well on buttermilk as a rule. It 
may be obtained now from many dairies or it may be pre- 
pared at home by the use of numerous tablets sold in drug 
stores and having directions for use with them. The milk 
should usually be skimmed before the tablets are added 
to it, unless otherwise specified by the physician in charge.. 
Milk laboratories sell special milk of this nature called 
^'lactic acid'' milk. For older children the milk may be 
given plain, but for babies under one year of age it is 
usually better to dilute it one-third or sometimes one-half 
with boiled water or barley water. 

Casein Milk or Protein Milk. — In this milk much of the 
sugar has been removed and the casein has been increased. 
It is used in cases of indigestion accompanied by thin or 



EECIPES FOE FOOD 29 

sour stools; sometimes maras'mus babies do well on this 
food. 

One quart of whole milk is coagulated by rennet^ as in 
the case of making whey {see page 28) ; all whey is then 
strained off and thrown away. The remaining curd is 
carefully rubbed through a fine wire sieve and one pint 
of buttermilk is added. Add enough water to make the 
whole mixture one quart. 

Older children take this just as it is^ but babies often 
have to have it diluted with equal parts of water^ the 
water being gradually lessened. When the child^s stools 
become more normal malt sugar may be added gradually 
to this mixture. Then plain milk mixtures should be 
tried one or two feedings per day^ working back little by 
little until the baby can take his usual food. This milk 
is called "Eiweiss'' milk by the Germans. 

Keller's Malt Soup, — Three ounces of wheat flour, by 
volume, three and one-half ounces Loeflund^s malt soup 
extract, sixteen ounces of water, sixteen ounces of whole 
milk. Mix the malt extract with warm water, carefully 
rub up the flour with the milk and strain. Next mix all 
the ingredients thoroughly and bring them to the boiling 
point slowly with constant stirring. For very young in- 
fants this may be then diluted with an equal amount of 
water; for older babies give as it is. 

If fat indigestion is the trouble, then it is often best to 
use skimmed milk. The formula may be worked up or 
down according to the digestion of the individual child. 
Sometimes it is possible to gradually increase the milk to 
two-thirds or even three-fourths of the total amount of 
food. 



30 GENEEAL CAEE OF SICK CHILDREN 

In difficult feeding cases and often for marasmus babies 
this food is tried with more or less success. 

Broths, — The important feature in making broths for 
sick children is to be sure that every particle of fat has 
been removed. Whenever it is possible the broths should 
be made the previous day and left on ice over night; then 
all fat will come to the surface and may be removed. 

One pound of finely chopped mutton, beef, veal or 
chicken, with a little of the bone and as free from fat as 
possible, one pint of cold water and a pinch of salt, should' 
be cooked for three or four hours over a slow fire down to 
half a pint. Water may be added from time to time if 
needed. 

This should be strained through muslin, chilled in the 
ice box and then all fat removed. It may be warmed when 
fed or it may be given cold in the form of a jelly. It may 
be diluted with barley or rice water or it may have some 
barley or rice cooked in it for older children if desired. 

Clam Broth. — Heat one and one-half cups of clam juice 
to boiling point, add a tiny pinch of bicarbonate of soda. 
Heat one-half cup of milk in another saucepan and add a 
pinch of bicarbonate of soda, a speck of butter and salt 
to this, bring to boiling point and then add the hot clam 
juice. Let it come to boil once. Then remove from fire 
and strain through very fine sieve or cheesecloth. 

Beef Juice, Cold Process. — Take half a pound of round 
steak finely chopped, three ounces of cold water, a pinch 
of salt; place in a covered glass jar and stand on ice over 
night ; the next morning pour it all into coarse muslin and 
twist well so that all the juice is squeezed out of the meat. 
It may be given warm or cold. 



EECIPES FOE FOOD 



Beef Juice, Warm Process. — Very slightly broil half a 
pound steak cut thick ; place in a lemon or meat press and 
squeeze all the juice out of it; add a pinch of salt. If 
given warm a cup containing the beef juice should be 
placed in another cup or pan of hot water and only 
slightly heated, for if heated too much it will curdle. 

Potato Soup or Puree, — Take one quart of milk, six 
large potatoes, a stalk of celery, a tablespoonful of butter. 
Boil the pared potatoes for thirty minutes, then pour off 
the water and mash very fine and light; boil the celery 
in the milk, then add to the potatoes; salt a little, and 
Tub through a strainer, serving at once. 

Cream of Celery Soup. — Boil a head of celery in a pint 
of water for thirty or forty-five minutes; mix a table- 
spoonful of flour with two tablespoonfuls of cold milk 
and add to a pint of boiling milk; mash the celery in the 
water in which it was cooked and stir into the boiling 
milk; add a tablespoonful of butter and a pinch of salt; 
strain and serve at once. 

Similar soups or purees may be made from peas, beans 
and spinach. These soups are excellent to give children 
in summer or when there is a tendency to rheumatism, 
and meats and animal broths must be used sparingly. 

Albumin or Egg Water, — For vomiting babies and in 
some cases of diarrhea, this is often prescribed. It will 
not sustain life for any length of time but may tide a 
child over for a few hours until the stomach and bowels 
can bear other food. 

The white of one fresh egg, half a pint of cold water 
and a pinch of salt should all be shaken together thor- 
oughly. One teaspoonful of brandy may be added if the 



32 GENEEAL CAEE OF SICK CHILDEEN 

child is weak. It may be fed from a nursing-bottle or 
spoon from one teaspoonful to two ounces at a time every 
hour or two. 

Lime Water. — It is better to buy lime water already pre- 
pared in a drug store if possible^ but when it must be 
made at home one teaspoonful of slaked lime should be 
added to one quart of boiled or distilled water. This 
should be placed in a corked bottle and shaken well several 
times during the first hour. It should then be left undis- 
turbed for twenty-four hours so that all lime is allowed 
to settle; then the upper perfectly clear fluid should be 
most carefully poured or siphoned off. There should be 
no sediment in the part that is used. 

Egg Nog. — Have the egg very cold. Separate the white 
and yolk ; beat the yolk well ; stir into this one teaspoonful 
of sugar; add a tiny pinch of salt and one-half cup of 
cold milk. Beat this all well together and add the white 
of the egg beaten to a stiff froth and gently mix^ leaving 
some of the white on top. Flavor with a little nutmeg 
on top if this is liked;, or add one teaspoonful of sherry 
wine^ or the same amount of brandy if the child is tak- 
ing a stimulant. 

Milk Punch. — One cup of milk^ one teaspoonful of 
sherry wine, brandy or rum, two teaspoonfuls of sugar. 
Shake all well together in a fruit jar until frothy. 

Coddled Egg. — Place the egg in enough boiling water 
to cover it/ and immediately remove the water from the 
fire so that as it cools the egg cooks slowly and thor- 
oughly; it should be left in the water for seven or eight 
minutes. When the egg is broken open the white should 
look like a jelly. 



EECIPES FOE FOOD 



Scraped Beef Pulp. — One-half a pound of round steak 
should be scraped with the end of a tablespoon on both 
sides so that only the pulp and none of the fiber is ob- 
tained. This should be placed in a deep saucer and a 
pinch of salt and a speck of butter added to it. It should 
then be covered by another saucer and placed over the tea- 
kettlC;, the lid of which has been removed. It should be 
turned from time to time with a fork until it looks rare 
but is heated through. Usually less than five minutes will 
do it. 

This may be used also for thin delicate beef sandwiches 
either entirely raw or heated through in this manner. It is 
easy to digest and good for anemic children as well as for 
many other diseases. 

Irish Moss Blanc Mange. — This is a delicious food and 
dessert often ordered for a convalescent child from the 
age of one year upwards. 

The moss may be gathered on many of the Xew Eng- 
land coasts and dried^ or it may be bought in a drug 
store. 

Soak one-quarter of a cup of Irish Moss in one and 
one-half cups of cold water for fifteen minutes; then re- 
move and pick over and put into a double boiler with 
one and three-quarter cups of milk. It should be cooked 
for about twenty minutes or until a little dropped on 
a cold plate will thicken. Add one-quarter of a salt- 
spoon of salt, then strain and add one-third of a tea- 
spoonful of Burnett's vanilla. Strain again and pour into 
cold, wet molds. It should then be thoroughly chilled and 
served with a little cream and sugar. 

Orange Jelly. — One teaspoonful of granulated gelatin 



34 GENEEAL CAEE OF SICK CHILDEEN 

should be soaked in one tablespoonful of cold water half 
an hour. Then add one tablespoonful of boiling water and 
dissolve it. Add two tablespoonfuls of sugar and three 
tablespoonfuls of orange juice and two teaspoonfuls of 
lemon juice and strain through a cloth and strainer into 
cold wet molds. Chill and serve with a little top milk 
or plain. 

Wine Jelly, — Wine jelly is made in the same way as 
orange jelly but sherry wine is substituted for the orange 
juice. 

Junket. — Warm a pint of fresh milk to 98 or 100 degrees 
Fahrenheit; add a teaspoonful of sugar^ a pinch of salt 
and two teaspoonfuls of essence of pepsin, liquid rennet or 
a junket tablet; stir for a moment, and then allow it to 
stand until firmly clotted, which will take about twenty 
minutes at the temperature of the room; then place on 
ice. 

Vanilla Ice Cream. — Mix the following ingredients well : 
one-half cup of milk, one-half cup of cream, three table- 
spoonfuls of sugar, one-half teaspoonful of Burnett^s va- 
nilla, and a pinch of salt. When the sugar is dissolved 
freeze in a small freezer. 

Junket frozen makes an excellent ice cream for delicate 
or sick children. 

Laxative Foods 

Bran Gems. — Mix together one quart of bran, one pint 
of flour, one pint of milk, twelve tablespoonfuls of molasses, 
one tablespoonful of soda and a pinch of salt. Bake in 
gem-pans. 

Prune Jelly. — Soak the prunes over night in cold water. 



MILK AND EGG IDIOSYNCRASY 35 

Next morning pour off this water and add enough fresh 
water to cover them; stew them slowly for an hour or 
twO;, adding water from time to time^ then rub them 
through a sieve; add a tablespoonful of molasses to 
each pint of prune pulp and stew again for half an 
hour. 

Graham Mush. — Cook half a pint of water^ two table- 
spoonfuls of graham meal and a pinch of salt for one 
hour in a double boiler or a steamer; then add a pint of 
milk and scald or steam for five or ten minutes; strain 
and keep on ice until needed^ when the mush may be 
warmed. 

MILK AND EGG IDIOSYNCRASY 

It is very seldom that a baby cannot take milk ; usually 
if trouble is found it is due to the fact that the correct 
formula for that particular child has not been found. 
When it is found impossible to modify milk so that a 
baby can take it one will generally find that something 
wrong was given to the child at the start of his life 
and this has so upset him that he cannot be made to 
digest any form of milk. 

Cases of pure milk idiosyncrasy are rare but possible. 
In such cases it is extremely difficult to decide what is best 
to do. Each baby differs in his ability to digest the dif- 
ferent foods usually tried at such times. 

If a good wet nurse can be obtained it is generally best 
to make an attempt to use breast milk first. If this cannot 
be taken, then protein milk or buttermilk may be tried 
next. Condensed milk mixed with a cereal gruel. Ramo- 
gen, and the various prepared foods are usually then given 



36 GENEEAL CAEE OF SICK CHILDEEN 

a trial. But each thing should be give» a fair trial and 
not given up at the first sign of disagreement. 

Children who cannot take fresh cow's milk should be 
given fat-free broths^, beef juice, and fruit juices early. 
They should also be given semisolids like well cooked 
cereals, milk toast, scraped beef, etc., much earlier than 
a normal child, so that the food which takes the place 
of the usual milk will not have to be given in as large 
a quantity as would otherwise be necessary and the baby 
can be gradually trained to do without it altogether. 

There are also a few children who cannot digest eggs. 
Violent symptoms of acute poisoning are seen almost as 
soon as an egg is taken. The child may vomit or his 
temperature may become elevated and bright red blotches 
break out all over him. When these symptoms are seen 
it is not worth while to persist in giving eggs. Broths, 
beef juice, and later meat and fish will have to be substi- 
tuted. Sometimes this idosyncrasy is outgrown in later 
life. 



CHAPTEE II 

PECULIARITIES OF DISEASE IN CHILDREN AND 
SPECIAL METHODS OF TREATMENT 

In taking care of a sick child one has to depend largely 
on what can be personally observed. The infant and young 
child cannot locate pain^ and even if they do it is often 
referred to the wrong place. Keen observation on the 
part of the mother or nurse is therefore essential to the 
successful nursing of the sick child. 

Some of the chief points to be watched in caring for the 
sick child are the following: 

1. General Nutrition, Is he gaining or losing flesh? 

2. The Expression. Is he bright or dull and stupid ? Is 
he fretful or peaceful? Is his face drawn as if in 
pain? 

3. Character of the Breathing. Is it rapid or slow? Is 
it regular or jerky? Does he breathe with the mouth 
closed or open? Is the breathing noisy as from snoring, 
or does it rattle from mucus? Do the nostrils work 
when the child breathes as if it was very difficult to get 
his breath? Is there a cry of pain when a deep breath 
is drawn? 

4. The Nervous Condition, Is the child restless and 
excitable or drowsy ? How is the sleep, quiet or restless ? 
Is there any muscular jerking or twitching? 

4 37 



28 PECULIAEITIES OF DISEASE IN CHILDEEN 

5. Favorite Position, How does the child prefer to lie, 
stand, or sit? 

6. Character of the Color of the Shin, Especially of the 
Face and Extremities, Is he pale, blue, flushed, or are 
the lips cracked as if from fever, or dry ? 

7. Condition of the Tongue, Is it coated white, or 
brown, or unusually red? Is it dry, or is there more 
secretion of the saliva than usual? 

8. The Cry, Is it sharp and piercing, as from acute 
pain, or is it simply a cry of the spoiled child which 
ceases the minute he gets what he wants? 

Walking, rocking, etc., will not cause a sick child to 
cease crying if the pain is acute. The cry of meningitis 
is very sharp and different from almost any other cry. The 
fretful whine of marasmus is often characteristic of this 
disease. The feeble moan of a baby too weak to cry loud, 
the hoarse cry of babies with diseases of the throat — all 
are different and usually help in deciding wherein the 
trouble lies. 

What we call the ''vital signs'' are the pulse, respiration 
and temperature. These signs in children differ very much 
from those observed in adults. They are much more easily 
upset on account of the highly strung and rapidly de- 
veloping nervous system in babies and young children. 
Consequently a rapid pulse, or respiration and high fever 
in a baby need not cause as much alarm as the correspond- 
ing condition in adults, if it is of short duration. These 
symptoms continuing any length of time are of course 
very grave. If the temperature remains above 100° F., a 
doctor should always be called after twenty-four hours at 
least. 



PULSE 39 



PULSE 



To take the pulse of a baby or young child is often dif- 
ficult and usually beyond the mother^s sphere of work^ 
but if necessary she may try to take it by placing her 
finger on the baby's wrist on the thumb side where the 
hand joins the arm and after waiting until she feels the 
regular beat she should begin to county counting care- 
fully for a full minute at least. 

According to Holt^ the normal pulse of a baby 

From six to twelve months of age is 105 to 115 beats each 
minute. 
From two to six years it is 90 to 105 beats each minute. 
From seven to ten years it is 80 to 90 beats each minute. 
From eleven to fourteen years, 75 to 85 beats each minute. 

Anything very much higher or lower than these figures^ 
if it continues more than twenty-four hours, should cause 
the mother to consult her doctor. If possible it is better 
to take the pulse and respiration when the child is asleep. 
Only a doctor or trained nurse can judge as to the regu- 
larity and other characteristic features of the pulse. 

The Respiration 

To count the respirations of a baby or child is often even 
more difficult than the pulse and must be done when asleep 
if possible. The mother may then very gently place her 
hand on the child's chest and begin the count. Holt gives 
the following figures for respiration during one minute 
while the child is asleep : 



40 PECITLIAEITIES OF DISEASE IN CHILDEEN 

At birth 35 per minute 

At the end of the first year 27 per minute 

At two years 25 per minute 

At six years 22 per minute 

At twelve years 20 per minute 

Other characteristics of the breathing must be left to 
the trained nurse and doctor. The mother can simply take 
the count if necessary and report any abnormality to the 
doctor if it continues more than twenty-four hours. 

THE TEMPERATURE 

This varies greatly and is much more easily affected 
by very slight causes than in the case of adults. A tem- 



FiG. 3. — Clinical Thermoi^ieter. (Courtesy of Whitall Tatum 
Co., New York.) 

perature that would be considered alarming in a grown 
person need cause no alarm at all in a baby ^provided it 
does not continue, A good clinical thermometer should 
be owned by every mother and kept clean ready for use. 
The rectal temperature is the best until the child is at 
least six years old. The thermometer should be greased 
"with vaselin^ then inserted into the rectum — about one 
inch usually — and left in place three minutes; it should 
then be withdrawn and carefully read and noted on paper. 
The rectal temperature is usually from one-half to one 
degree higher than that taken in the armpit or groin or 
even in the mouth. The thermometer should be cleaned 



THE UKINE 41 



by wiping it off with a piece of cotton dipped in alcohol 
or biehlorid solution 1-1000. 

At birth the temperature is usually that of the mother 
and soon becomes 99° F. It varies from 981/^ to 99 "^ 
throughout the greater part of infancy and childhood. Any 
temperature over 100° should be reported to a doctor if 
it continues more than twenty-four hours. There is usually 
a cause and it should be found if possible. Subnormal 
temperatures as 97° or lower should also be reported if 
they are continuous. Hot water bags packed about a 
baby may send the temperature up to quite a high 
degree. 

THE URINE 

The mother should have some idea as to the proper ap- 
pearance and amount of urine passed normally in twenty- 
four hours^ in order to determine when conditions are 
not normal. At birth the urine passed is very small in 
amount — two to eight ounces being the average. It is 
almost colorless. During the first week it often becomes 
dark in color and stains the napkin; this is due to uric 
acid. If the baby is given pure, boiled water — an ounce 
between each meal — the urine will soon become light or 
pale amber in color. Any fever will usually make the 
urine highly colored and less in amount. 

A %rick dust^^ deposit is sometimes seen in the chamber 
or napkin of babies or young children; this usually indi- 
cates some form of indigestion, or a tendency to gout and 
rheumatism in a family that have had these diseases. In 
such cases it is well to cut off all sugar for a while, and 
as much starch as possible: that means in an infant. 



42 PECULIAEITIES OF DISEASE IN CHILDREN 

diluting the milk with water, and leaving out the sugar 
in the formula, and in an older child, giving few, if any 
cereals, but milk, green vegetables, white meat of chicken 
and milk desserts without sugar, and some white fish. 
Plenty of water must be taken, and Vichy is often ex- 
cellent. 

The following table, taken from Dr. Holt's "^^Diseases 
of Infancy and Childhood,"' may be helpful : 

Average Daily Quantity of Urine in Health 

First twenty-four hours to 2 ounces 

Second twenty-four hours % to 3 ounces 

Three to six days 3 to 8 ounces 

Seven days to two months 5 to 13 ounces 

Two to six months 7 to 16 ounces 

Six months to two years 8 to 20 ounces 

Two to five years 16 to 26 ounces 

Five to eight years 20 to 40 ounces 

Eight to fourteen years 32 to 48 ounces 

Sugar, albumen, pus, blood and other substances occur 
at times in the urine of babies and children, but it is not 
possible for a mother to detect these things; all she can 
do is to collect a specimen for the doctor, and have him 
make a careful analysis. Many doctors, unfortunately, 
do not consider this necessary when they are treating 
babies, or do not think it is possible to get a specimen. 
A wise mother will insist upon having this done, if there 
is anything at all obscure in the illness of her child, and 
through the information obtained By the analysis, a dis- 
ease that has heretofore been very little understood may 
suddenly become very clear and easy to treat. 



THE UEINE 43 



To collect a specimen of urine in a baby who cannot 
make its wants known^ in the case of a boy, a bottle may 
be placed inside of the diaper, the penis being placed in 
the bottle, and it may be held in place by bands of ad~ 
hesive plaster or by tapes tied around the neck of the 
bottle and around the thighs of the baby. This bottle 
should be placed there just as the child is to be fed, as 
during and right after a meal he is more apt to pass 
urine. A soft rubber bag, if one can be obtained, is even 
better than a bottle for this purpose. There is also now 
made a special contrivance for collecting urine. In a little 
girl, a small cup may be placed inside the napkin and 
the napkin then pinned up tightly, or if this is not feasible, 
some perfectly clean absorbent cotton, or a clean, new 
sponge, may be placed there, and carefully watched, so 
that as soon as it is wet it may be removed and squeezed 
into a clean bottle. All receptacles for collecting urine 
must be absolutely clean and free from other substances,, 
or the value of the test will be lost. A baby over six 
weeks old may be held on a small chamber every twenty 
minutes or half hour, until the urine is collected. A hot,, 
damp cloth over the bladder, or if this fails, a cold one,. 
will often cause a child to pass urine; this may always be 
tried when a child does not pass urine frequently enough. 
Frequently the urine will have a very strong odor of 
ammonia ; often such urine will blister the parts on which 
it falls. Eecent investigations have shown that many 
times this is caused by diapers not being properly rinsed, 
and the urine that falls on them thus develops ammonia 
in a free state, and this causes the skin irritations. Xo 
soap should ever be left in diapers. Sometimes this am- 



44 PECULIAKITIES OF DISEASE m CHILDEEN 

monia urine may point to the fact that the child is not 
getting enough water or that the stools passed are not 
normal;, there being some indigestion also. At other times 
it is impossible to account for this condition. 

Enuresis or Incontinence of Urine 

When a child has reached his third year and still cannot 
control the passage of his urine he is said to have "in- 
continence of urine/^ He should go from eight to nine 
hours at night without wetting, and two or three hours in 
the day time; if he cannot do this something is wrong, 
and medical attention should be sought. Before this age it 
may be simply normal;, or else due to bad training, if the 
child has to empty the bladder so often. Eewards are often 
more effectual than punishments in controlling this habit. 

Causes, — Many times this incontinence of urine is simply 
a bad habit in children whose training has been neglected, 
but in well brought up children it is usually a form 
of nervousness, and often very difficult to overcome. 
Anemia, and any debilitated state of the system^, tight fore- 
skin or vaginitis, intestinal worms, too acid urine, or 
other abnormal conditions cause it. The incontinence may 
be only during the night, or possibly both day and night. 
Adenoids and enlarged tonsils are quite a frequent cause, 
and should always be thought of when a child has this 
difficulty. 

Symptoms. — There is not a dribbling of the urine, but 
a complete emptying of the bladder in this disease. Much 
more frequently is there night incontinence than both day 
and night. The bed may be wet, not only once but several 



THE TJEINE 45 



times during the night. This condition may last for 
months or even years — it is often exceedingly difficult 
to cure. 

Treatment, — This depends upon the cause. The urine 
should be examined by a doctor^ and anything abnormal, if 
found, should be righted. If the foreskin is tight the child 
should be circumcised. If adenoids or enlarged tonsils are 
present they should be removed. Careful watch of the 
movements for worms should be kept. If the child is 
anemic and run down, he should be given nourishing food, 
taken away for a change of air if possible, kept out of 
doors as many hours as possible, and given an iron tonic. 
If the bed is wet at night, and the child able to control 
himself during the day, it will be advisable to try a dry 
supper. It would be well to give him a glass of milk 
at four p. M. and absolutely no fluid after that until the 
next morning. 

For supper, a cereal with a little butter on it, bread 
and butter, and a little well stewed fruit with a cracker 
may be given. The child should be made to empty the 
bladder just before he gets into bed and should then 
be taken up at ten or eleven o^clock, when the parents 
retire, and made to use his chair again. In this way 
he is often able to hold the urine until five or six o^clock in 
the morning. In cases that fail to respond to any of the 
above treatments it will be necessary to put the child 
directly under a physician^s care, and he will prescribe the 
drug best suited to the individual case 

A solution of atropin is many times prescribed, but a 
child while taking this must be watched by a doctor, or 
poisoning may result. One drop of the solution is usually 



46 PECTJLIARITIES OF DISEASE IN CHILDREN 

given three times a day^ and the dose gradually increased, 
until the child is taking as many drops as he is years old; 
then the dose is gradually decreased. The child may flush 
very bright red while taking this solution^ and if this 
occurs often the drug should be stopped or the dose at 
least diminished. Strychnin is another drug often pre- 
scribed. Great care is necessary in its administration^ and 
no mother should attempt to give it on her ot\ti responsi- 
bility. Unlimited patience is necessary in treating this 
disease, and it may be necessary to continue the treat- 
ment for a year or more before the child is entirely 
cured. The mother must heartily cooperate with the physi- 
cian, or else nothing can be accomplished. 

THE ADMINISTRATION OF MEDICINE TO THE SICK 

CHILD 

In the care of sick children medicine plays one of the 
least important parts. Good food, good nursing, and ex- 
ternal treatment such as will be described, with change 
of climate when necessary, are many times more im- 
portant than medicines but sometimes they are needed to 
aid nature rid the system of its poisons or to stimulate 
the overworked heart. When medicine is needed let the 
doctor prescribe it. Never run to a drug store and get 
what the druggist prescribes. A mother may give a dose 
of castoi oil or some simple laxative medicine when needed 
but never is it advisable for her to prescribe anything else 
that must be taken into the child^s stomach. Upsetting 
the stomach and intestines in the beginning of a serious 
illness makes the chance of recovery many times less 



THE ADMIIs^ISTEATION OF MEDICINE 47 

likely. These organs of digestion must be most care- 
fully guarded. 

It is usually best to give castor oil the first thing in 
the morning, when the stomach is empty; otherwise it 
should be given midway between meals. It will often be 
vomited if given on a full stomach. If the mother will 
go about giving the oil in a perfectly natural and business- 
like manner and not make the child think he is getting 
a noxious dose by pitying him he will often take it without 
the least trouble. The attitude of the mother has more 
to do with the successful nursing of the sick child than 
anyone is apt to realize. Castor oil may be given in a 
little orange juice to a child of one year or older or a 
little syrup of sarsaparilla may be used if the child ob- 
jects very much to the dose as it is. Older children may 
take it in a little black coffee. Capsules of castor oil may 
be given if the child will swallow them easily, or specially 
flavored castor oil may sometimes be used if thought best. 
A piece of dry bread eaten after the oil will quickly rid 
the child of the unpleasant taste. It will be found helpful 
to either heat the spoon in which the oil is given or to 
give it ice cold. The dose of castor oil for a baby under 
one year of age is one teaspoonful. At one year it is two 
teaspoonfuls, and after this time usually one tablespoonful. 1 
If one dose is vomited wait half an hour and then try it 
again. If the oil is placed far back on the tongue it will 
be swallowed more quickly and tasted less than if given in 
the front of the mouth. 

Milk of magnesia is a safe and effectual laxative for a 
mother to give. It should be given in about equal parts 
of water, or better still, may be added to the bottle or 



48 PECULIAEITIES OF DISEASE IN CHILDREN 

Clip of milk if the child is taking milk. Under one year 
of age from one-half to one teaspoonful given once or 
twice daily will usually be the correct dose. At one year 
two teaspoonfnls are often needed and after this age 
usually a tablespoonfnl. Children differ much in their 
response to laxatives. 

Many mothers look upon calomel as a home remedy to 
be given by themselves whenever they think it is neces- 
sary. Others so dread the thought of giving it at all they 
strongly object even when the family physician prescribes 
it. Babies and young children stand calomel well as a 
general things but it is not by any means a ^^home remedy .^^ 
It is a form of mercury and may cause grave trouble if 
given unwisely, while in many cases it is the one drug that 
will quickly cure the child. Therefore, the mother should 
always consult her physician before giving a dose of 
calomel. If it is impossible to reach a doctor and the 
child is apt to need calomel, it is occasionally permissible 
for the mother to give a dose, if from previous experience 
she knows that it agreed with the child when it was 
ordered by her doctor. The frequent and habitual giving 
of calomel by the mother is to be prohibited. It should 
be given in small divided doses. The correct dose for a 
baby under two years of age is one-tenth of a grain every 
hour until ten doses have been taken. After this time a 
child can generally take one-fifth of a grain or one-quarter 
of a grain every hour for six doses. I have found that if 
it is given every hour instead of more frequently, as some 
physicians advise, it is far more apt to be retained by 
the child and be of more benefit. Babies under one year 
of age seldom need anything to carry off the calomel. 



THE ADMINISTEATION OF MEDICINE 



49 



but after this age it is often advisable to give a dose of 
the citrate or milk of magnesia the morning after the 
calomel has been taken. It must pass through the bowels 
and not be allowed to accumulate in the system. Orange 
juice or acids should never be given the day the calomel is 
being administered. 

Mothers should bear in mind never to give patent 




Fig. 4, — Minim Glass. (Coiirtesv of WhitaU Tatum Co., New 

York.) 



medicines on the recommendation of neighbors: soothing 
syrupS;, etc.^ contain opium and other harmful drugs. 
^^Teething powders'^ and tablets should be left absolutely 
alone. Babies have been known to go to sleep and never 
wake up from doses of patent medicines. 

When a doctor orders medicine the mother should keep 
an exact record of the dose given and the time it was 
administered. The memory should not be relied upon, but 
a memorandum should be made and referred to. Extreme 
care should be exerted to drop the medicine with a medi- 
cine dropper if drops are ordered and not guess at it or 
try to drop it from the bottle itself. Drops and minims 
are quite different in many medicines and if a doctor 
orders medicine by minims the mother will need a special 



50 PECULIAEITIES OF DISEASE IN CHILDREN 

glass with minims marked on it. It is always better to 
measure medicine in a graduated medicine glass than in 
a teaspoon or tablespoon. The mother must be careful 
to wash the glass or spoon well after each dose and if 




Fig. 5. — Medichste Glass. (Courtesy of Whitall Tatum Co., 

New York.) 

the doctor leaves medicine in a glass it must be kept 
well covered. All medicines must be kept out of the 
reach of the children; serious accidents have happened 
by children swallowing drugs. The neck of a medicine 
bottle must be kept clean^ pouring the dose out on the 



Fig. 6. — Medicine Dropper. (Courtesy of Whitall Tatuni Co., 

New York.) 

side opposite the label and wiping the neck of the bottle 
with a damp cloth. It is of the greatest importance to 
look at the label on the bottle before measuring the dose, 
after it is measured, and when putting the bottle back in 
place ; then the mistake of giving the wrong medicine will 
be an impossibility. 



THE ADMINISTEATION OF MEDICINE 51 

In many cases young babies — ^before they have any 
teeth — may be given a dose of medicine by a medicine 
dropper more easily than from a spoon. The dropper 
should be placed far back in the mouth and then the 
bulb slowly squeezed^ when the medicine will trickle down 
the throat. The nose may be held if the baby refuses to 
swallow^ as this helps some. 

As children do not as a rule take pills^ tablets^ or cap- 
sules well;, it is usually necessary to crush these and give 
them in a little water or jelly, and follow this with a 
drink of water. A bitter medicine will often be taken 
very well if diluted by water. 

If a medicine is ordered ^^after meals^' usually fifteen to 
twenty minutes after is meant, and if ^^before meals'^ the 
same time should usually elapse unless otherwise stated 
by the doctor. The regularity with which medicine is 
given often means a great deal and the mother must 
see that the doctor^s orders are carried out exactly in this 
respect. 

Some forms of iron and acids are apt to injure the 
teeth and should be given by means of a glass tube. Great 
care should be taken to see that the child does not bite 
the glass tube or medicine glass. It is safer to use a 
spoon or cup if possible to administer the dose after it 
has been measured in the glass. 

It is seldom possible to make a child retain medicine 
by the rectum but in some cases it may be necessary to 
try this. The mother should receive special instructions 
from her doctor in each case. It is usually necessary to 
elevate the buttocks and hold the anus together for a 
few minutes after the dose has been given by rectum. 



52 PECULIAEITIES OF DISEASE IN CHILDKEN 

Medicines are also given by hypodermic needles but these 
are not for a mother to handle. The doctor or a trained 
nurse must administer such doses. 

Giving candy after a dose of medicine is not to be 
encouraged. 

METHODS OF TREATING DISEASE IN THE SICK 
CHILD 

While there are times when the giving of suitable drugs 
will no doubt save the life of a sick child^ they are to 
be thought of as a last resort and other means of treat- 
ment must be employed first in almost every case. As al- 
ready stated, no mother should undertake to dose her own 
child, with the exception of castor oil and some mild laxa- 
tives. If the child is sufficiently ill to need other medi- 
cines he is sufficiently ill to have a doctor. Patent medi- 
cines should never be employed without the written orders 
of the family physician. There are other methods than 
drug giving that may be used in treating sick children. 
Some of these are the following: diet, baths, irrigations 
and enemata, stomach washing, applications of heat and 
cold, inhalations, sprays and douches, counterirritants, 
massage, electricity, change of climate. 

Diet 

Diet will be taken up in connection with special dis- 
eases. 

Baths 

Baths for medicinal purposes are the hot bath, vapor 
bath, mustard bath, bran bath, tepid bath, salt water bath. 



TKEATING DISEASE IN THE SICK CHILD 63 

cold sponge bath^ shower bath, soda bath, starch bath, 
alcohol sponge bath, and the cold tub bath. 

Hot Bath. — This is most often used in cases of collapse 
or shock; sometimes for convulsions. The child should be 
put into the tub at a temperature of 100° and hot water 
gradually added until it reaches a temperature of 103° to 
106°. A bath thermometer should be used. The mother 
should not depend on her own hand for this as this may 
cause burning of the child. If a thermometer is not avail- 
able the water may be tested with the bare elbow. Usually 
cold cloths or an icecap should be kept on the child's head 
while the hot bath is being given ; from five to ten minutes 
is generally enough to allow for this bath. The child 
should then be wrapped in a large towel inside of a warm 
dry blanket and placed in bed with a hot water bag to his 
feet. A little later the towel should be slipped out and 
the child allowed to lie in the warm blanket for an hour 
or so. If convulsions have been present or marked nervous 
symptoms the ice bag should be kept at the head. 

Hot Air or Vapor Bath, — This is often used in cases of 
kidney disease where it is necessary to have the child 
perspire in order to open the pores of the skin and elimi- 
nate poisons. 

The patient should be undressed and placed in his bed 
on a blanket; the bed clothing should be raised above 
his body ten or twelve inches by means of some support 
like barrel hoops or wicker arrangement which comes 
for this purpose, or a child's chair may be used. There 
must be this space like a tent to collect the vapor. The 
bed clothing should be pinned tightly around the neck 
so that the head alone is outside and no air allowed to 
5 



54 PECULIAEITIES OF DISEASE IN CHILDREN 

escape. A croup kettle having a long nozzle is then used 
to conduct steam under the covers. Great care must be 
taken to see that the child is not in too close contact with 
the steam as it issues directly from the kettle. This may 
be continued for twenty minutes or half an hour at a 
time and the child will usually perspire freely. The steam 
may be stopped then but the child kept under the blankets 
a while longer and only very gradually taken out of this 
vapor bath so that sudden chilling is prevented. He 
should be dressed in a warm nightdress and have a hot 
water bag at his feet when finally taken out of the vapor 
bath. 

Mustard Bath. — Mix five tablespoonfuls of mustard with 
a little cold water to a smooth paste, then add this to 
four or five gallons of water at 100° F. ; stir well so there 
shall be no lumps of mustard in the water. 

The child should then be placed in this bath. The 
water may then be gradually made warmer by pouring in 
hot water until the temperature reaches 105°. The child\s 
body should be covered up to the neck with this mustard 
water. The bath should be continued from five to ten 
minutes. If the child is convulsive an icecap or cold cloths 
should be kept at the head while this bath is being given. 
A bath thermometer should be used. The child's body 
should be wiped with a warm, dry towel when he is taken 
out of the bath and then he should lie undisturbed in a 
blanket for a while in the same manner as described for 
the hot bath. 

Mustard baths may be used for convulsions, shock, col- 
lapse, or for any purpose where it is thought best to bring 
the blood quickly to the surface of the body. 



TKEATING DISEASE IN THE SICK CHILD 55 

Bran Bath. — This bath is most often given for skin 
irritations^ like eczema^ severe cases of chafing, etc. One 
quart of wheat bran is pnt into a cheesecloth bag and 
squeezed about in four or five gallons of water, the tem- 
perature of which is best at 95^ to 98° F. The water 
should look milky or like a thin gruel. The baby should 
be kept in this bath three to five minutes, then wiped dry 
and dressed as usual. 

Tepid Bath, — This bath should be given at a tempera- 
ture of 95° to 100° F. It is the one usually employed dur- 
ing the first two years of life and may also be given to 
induce sleep or for a restless, nervous child as it is very 
soothing. The child should be kept in the tub only about 
three to five minutes, then gently wiped dry and clothed. 

Salt Water Bath. — One tablespoonful of salt to each 
gallon of water 95° to 98° F. is used. The child should 
be kept in this bath five to ten minutes and the body 
constantly rubbed all the time he is in the bath. 

It is useful for children who are poorly nourished or 
who need the gentle tonic effect that this bath gives. It 
may help those who perspire profusely. 

Cold Sponge or Shower Bath. — This should be given 
only on the advice of a physician. Many children cannot 
stand it, and rarely those under two years of age. If 
the child gets blue this bath should not be repeated. 

It should be given in the morning before breakfast 
and in a warm room. It is best to let the child stand 
in a foot tub containing enough warm water to cover 
the feet; then a bathroom spray should be used over the 
back and chest of the child, the water being from 40° to 
00° F., and continued only half a minute; if one has no 



56 PECULIAEITIES OF DISEASE IN CHILDEEN 

spray a large sponge may be used. At once this should 
be followed by a brisk rubbing with a soft but coarse bath- 
towel. The M^hole body should be rosy red and the child 
in a glow. Otherwise the bath should not be repeated as 
it will do more harm than good. 

For babies who are too young to stand and who need 
this cold bath for some special reason, a single dip in a 
tub of cold water temperature 50° to 60° F. may be 
used. 

The bath is usually given for its tonic effect in delicate 
children or in the case of babies who do not cry well. 
The sharp cry usually given on being immersed in the 
cold water expands the lungs and promotes circulation; 
some think it helps to ward off colds. 

Babies with atelectasis, or non-expansion of the lungs, 
are often given a hot bath first followed by the cold plunge, 
then the hot water dip, etc., for about three minutes at a 
time. It is best to end with the hot dip if the baby is 
very delicate. 

Soda Bath, — This is usually best given as a sponge 
bath but the child may be placed in the tub if thought 
best. 

One teaspoonful of bicarbonate of soda is added to each 
quart of tepid water 95° to 98° F., and the entire body 
sponged with a soft washcloth dipped in this water. 

It is especially useful in cases of prickly heat and such 
skin irritations. It often induces quiet sleep if given at 
bedtime when the child is restless and irritable on a hot 
day. After this bath the body should be gently patted 
with a soft linen towel and a little pure talcum powder 
dusted on the irritated portions of the skin. Several of 



TKEATING DISEASE IN THE SICK CHILD 57 

these baths may be given during each twenty-four hours 
if they seem to soothe the child. 

Starch Bath, — This is given in the same way and for 
the same purpose usually as the soda bath. One-half 
cupful of powdered laundry starch should be well mixed 
with the bathtub of water which should be from 95^ 
to 98° F. 

Alcohol Sponge Bath. — This is one of the most valuable 
means of reducing fever in babies and young children 
that we possess. It cools the body by evaporation and is 
of more value than all the medicines ever used for this 
purpose. 

Eight ounces of alcohol is added to one quart of water 
at 95° to 98° F. The child is gently sponged with a 
soft cloth dipped in this solution; this may be continued 
about ten to fifteen minutes at a time. An icecap or cold 
cloths should be kept on the head while the bath is 
being given. It relieves restlessness as well as reduces 
fever and may be repeated every two or three hours if 
needed. A light blanket should then be thrown over the 
child and he should not be dressed for an hour or so 
at least if the fever is high. 

Cold Tub Bath, — This is also used for reducing fever 
but I have not found it so generally beneficial as the sponge 
bath, as it is more exhausting. 

The shock is too great if the child is put at once into 
very cold water; therefore, he should be put into the tub 
at 100° F. and very cold water or ice gradually added 
to the water until it reaches 85° or 80° F. The body 
should be constantly rubbed while the child is in this bath 
and the head should also be bathed with cold water. It 



68 PECULIARITIES OF DISEASE IN CHILDREiSr 

is usually continued from five to ten minutes according 
to the way the child stands it. At the end of the bath 
the child should be gently wiped with a soft towel and 
wrapped in a warm blanket. This bath should be given 
only when ordered by a doctor. 

Mustard Foot Bath. — This is an old-fashioned remedy 
for a cold or chilling of any kind. It may be given in 
bed, as when used for the mustard pack, or if the child 
is not very ill he may sit up in a chair with his feet and 
legs in the deep foot tub of hot Avater and mustard, a 
large blanket enveloping both him and the tub. One 
tablespoonful of mustard to each gallon of water, the 
temperature of which is about 103° to 105°, is the usual 
proportion, and the feet should be left in from ten to 
fifteen minutes until they are quite red. They should 
then be well dried and the child placed in bed, a hot 
water bag at the feet. 

Packs 

A pack is often given a sick baby or child in place 
of a sponge or bath, as it is sometimes less exhausting 
than a full bath and accomplishes the same purpose. 

Cold Pack or Ice Pack. — Place a rubber sheet on the 
bed and on top of this an old blanket. Strip the child 
and roll him up in a sheet or large towel wrung out of 
water about 100° F. ; each arm and leg should be wrapped 
separately. Now rub him with pieces of ice about as 
large as the fist, being careful to include the armpits 
and groins in the ice rubbing as the large vessels lie close 
to the surface here and cool the body more readily. An 
icecap or cloth wrung out of ice water should be kept 



TEEATING DISEASE IN THE SICK CHILD 59 

on the head during this rubbing. The rub may be con- 
tinued for five to fifteen minutes according to the condition 
of the child. 

If he becomes blue or shivers it must be stopped as 
the shock is too great. He may be left in the sheet for 
twenty minutes after the ice rubbing and covered with 
a blanket. At the end of this time his temperature 
should be taken and if it has dropped 2 degrees or more the 
child should be dressed in his night clothes and the wet 
blanket and sheet removed. If not, it may be well to 
try the rubbing once more before the child is taken out 
of the wet sheet. The doctor must give careful orders 
about this for each case. If the hands and feet become 
cold a hot water bag must be kept at the feet even 
though the temperature is high and an icecap is on the 
head. This pack is used in cases of pneumonia or any 
other disease where sponging with alcohol does not give 
the desired effect. It is often useful in nervous children 
who run a very high temperature when ill. 

Mtistard Pack. — A rubber sheet and then an old blanket 
is laid on the bed and the stripped child on these. One 
tablespoonful of mustard is dissolved in one quart of 
water 98° F. and a large towel or small crib sheet is 
dipped into this and wrapped around the child while it is 
still very wet. The child is then covered with a blanket 
and he is allowed to remain in this pack for ten or fifteen 
minutes, when he should be dried and dressed in his night 
clothing; the skin should look quite red when he is taken 
out of this pack. 

This is given in cases of collapse or great prostration or 
sometimes in convulsions when it is thought best not 



60 PECTJLIAKITIES OF DISEASE IN CHILDREN 

to disturb the child enough to put him in a bath. If 
given for convulsions it is also a good plan to place the 
feet and legs in a deep basin of water at 102*^ to 103^ F. 
in which one tablespoonful of mustard to a gallon of the 
water has been thoroughly dissolved; this will quickly 
bring the blood away from the brain. An icecap should 
be kept at the head if the mustard pack is being given 
for this purpose. 

Hot Pack. — This is given as in the case of the mustard 
pack, but the towel or sheet is wrung from plain hot 
water at a temperature of 100° to 108° F. and the child 
then rolled in a blanket until he perspires freely. The 
hot towels or sheets may be changed for fresh hot ones 
every fifteen or twenty minutes if perspiration is not 
induced at first. It is often used in cases of kidney 
disease or uremia. 

Icecap 

This is a valuable aid in reducing fever and quieting a 
child as well as relieving acute congestion of certain parts, 
like the portion of the abdomen in which lies the ap- 
pendix. 

The icecap must be carefully watched and the ice re- 
newed in it as it has melted. The ice should be in small 
pieces; it may be wrapped in a strong cloth and pounded 
up with a hammer or broken with a large needle. It 
should be filled about half full with the ice and then 
all the air possible pressed out of the bag before the top 
is securely screwed on. If the screw-cap kind cannot be 
had, then a rubber bag which has to be tied around the 
top may have to be used. Care must be taken that there 



TREATING DISEASE IN THE SICK CHILD 61 

are no leakages in the top or holes in the other parts of 
the bag. A baby lying in a pool of water from a leaking 
icecap is liable to be made worse instead of better by 




Fig. 7. — Icecap. (Courtesy of Whitall Tatum Co., New York.) 

the treatment. The bag should be wrapped in a piece of 
gauze or a thin towel before placing on the child. 

Hot Water Bag * 

The greatest care must be observed when using hot water 
bags or bottles for a baby or young child. The top of the 
bag must fit tightly so that it will be impossible for a 
drop of water to ooze out and the bag must be hot without 
being hot enough to burn the baby. The bag should be 
filled only about three-quarters full of the hot water and 
then all air pressed out before the cap is put on; it 
will then lie flat. It should be wrapped in a flannel bag of 
its own or in a small blanket or towel before it is placed 
in the crib or bed. 

It is usually better to have the bag a little distance away 
from the feet or the body of the baby unless some special 



62 PECULIAKITIES OF DISEASE IN CHILDEEN 

orders are given by the doctor. The warmth will radiate 
from the bag and warm the child without danger of 
burning. If it is advisable to keep the bed constantly warm 
at least two hot water bags will be needed so that when 
one is cold the other is ready to slip right into its place 
without waiting. 

Hot Fomentations or Hot Stupes 

These are not used very much in treating infants and 
young children but some doctors like them for certain 
cases and the mother should know how to apply them if 
she is nursing her child. 

White flannel or a piece of heavy old wool blanket is 
the best material to use. A piece of this flannel the 
proper size for the part it is to cover should be placed 
in the middle of a towel and dipped in a basin of boiling 
water for a few minutes. When well saturated with the 
boiling water the two ends of the towel are twisted in 
opposite directions so as to wring out the flannel folded 
inside of it without burning one^s hands; this is then 
carried in the towel to the child, and the flannel shaken 
out and held to the mother's cheek just long enough to 
test the heat, as the child's skin is so delicate that burning 
is likely to take place unless great care is taken. The 
flannel is then placed on the part and covered with a 
piece of dry flannel and oil silk or some rubber material 
in order to prevent wetting the clothing, and a bandage 
is then applied to keep it in position. As soon as this 
cools a fresh hot one must be ready to slip in place. 

If the doctor orders a turpentine stupe or a laudanum 



TREATING DISEASE IN THE SICK CHILD 63 

stupe the same method is followed with the addition that 
after the flannel is wrung out^ from fifteen to twenty drops 
of laudanum or turpentine is sprinkled on the hot flannel. 
These stupes must be ordered by a doctor. 

Mustard Paste 

This is one of the most valuable remedies we have in 
infancy and childhood; it is called a "counterirritant.^^ 
Camphorated oil^ mentholatum^ capsicum vaselin, and the 
above-named stupes are also classed as counterirritants, 
but I never employ them when a mustard paste can be 
had; they are far inferior to the paste. The mustard 
leaves already put up may be used in an emergency^ as 
when travelings etc.^ but are not nearly so beneficial as 
the fresh homemade mustard paste. 

To make this paste take one tablespoonful of mustard 
and five tablespoonfuls of flour; mix well with enough 
lukewarm water to form a batter^ taking care that there 
are no lumps. Spread this betw^een two layers of thin 
muslin or thick cheesecloth; fold in the edges so it is not 
possible for the mustard to leak onto the child^ and 
apply it to the chest or part for which it is ordered. It 
usually takes from five to ten minutes for the skin to 
become well reddened; it should then be removed and a 
little olive oil or vaselin rubbed into the skin. For 
older children one tablespoonful of fresh mustard may 
be mixed with four tablespoonfuls of flour. 

If this paste is used for pneumonia or bronchitis it is 
usually best to make it large enough to surround the entire 
chesty instead of making two pastes, one for back and the 



64 PECULIARITIES OF DISEASE IN CHILDEEJST 

other for front of the chest; the parts under the arms 
often do not receive the benefit of the paste otherwise. 
The paste may be used every three hours if it helps the 
child;, a fresh paste being made each time. It will do 
the child more good than many bottles of cough medicines^ 
as it relieves the congested parts without upsetting the 
stomach. Besides being valuable in bronchitis and pneu- 
monia it often alleviates pain over the hearty and relieves 
violent vomiting if it is placed over the pit of the stomach 
about five minutes before the food is given. 

Mothers with little children should never be without a 
can of fresh mustard in the house. If it is old and stale 
it will be much less effective. 

Dry Cups 

This is another means of relieving acute congestion 
in pneumonia^, bronchitis, or other pulmonary troubles. It 
is rarely used by the mother. A nurse or doctor must 
generally do this, and should always personally teach the 
mother to apply these cups at least once if it is really 
necessary for her to use them; therefore the method 
will not be described here. More harm than good would 
come of the incorrect use of cups. Wet cups are not used 
for young children. 

Poultices 

These are of very little use for children; wet dressings 
and the mustard paste are much to be preferred. 

The old time flaxseed poultice for bronchial and lung 
troubles should not be employed for children; it only 
adds weight to the already tired-out chest walls. If for 



TEEATmG DISEASE IK THE SICK CHILD 65 

any special reason a doctor thinks best to use a flaxseed 
meal poultice the mother is usually the one who must 
prepare it and should remember to make it light. The 
water must be actually boiling and then the flaxseed meal 
stirred into this gradually until it is the consistency of 
mush and stiff enough to drop away from the spoon. It 
should then be taken from the fire and well beaten, no 
lumps being allowed to remain in it; this will make it 
light. The poultice is then spread evenly^ half an inch 
in thickness on a piece of cheesecloth or thin muslin which 
is placed on a hot plate. The edges of the muslin must 
be turned in to prevent the poultice from leaking and an- 
other piece placed over the top of this^, the edges being 
well turned under. It is then covered by a towel and 
carried to the child. The mother should hold it to her own 
face before applying it to the tender skin of the child. 
A flannel and oil silk of some rubberized material should 
cover the poultice and it should be held in place with a 
bandage or binder. Small poultices must be changed every 
hour or two, the larger ones every three hours. These 
should only be used when ordered by a physician. 

Enemata 

When it is necessary to empty the bowels quickly an 
enema or injection may be used; they should not be con- 
tinued day after day, however, as the habit is soon formed 
and the baby will depend upon this aid. Tlie amount 
of fluid given depends upon the age of the child: For 
a baby less than a year old from four to eight ounces 
of soap suds may be needed; older children usually ro- 



66 PECULIAKITIES OF DISEASE IN CHILDEEN 

quire a pint or sometimes more. It should be given luke- 
warm and by means of a fountain syringe, or in the case 
of young infants a small bulb syringe may be used. 

An olive oil enema may be used with benefit in the 
case of babies where the stools are hard and dry and 




Fig. 8. — Rectai. Syringe. (Courtesy of Whitall Tatum Co., New 

York.) 



difficult to pass. One to two ounces of olive oil with some- 
times one teaspoonful of glycerin to each ounce of the 
oil will be found valuable. The tip of the syringe must 
always be well greased with vaselin or olive oil and 
great care not to injure the delicate membranes of the 
bowels must be used. 

Irrigation of the Bowels 

This is a valuable aid in cleansing out the intestinal 
tract. To be of any real value it should be given with 
a soft rubber catheter having an eye or hole in the end 
and also one or two holes in the side of the catheter. The 
water will then flow into the intestines through the hole 
in the end and flow out again through the ones in the 
sides. 

Very often the mistake is made of inserting the catheter 



TEEATING DISEASE IN THE SICK CHILD 67 

only an inch or two into the lower bowel; it should be 
gently worked up as far as it will go without force — 
usually eight or nine inches. 

The catheter most often used is the No. 18 American 
scale. It is large enough and stiff enough to carry plenty 
of water and is not so apt to bend as a smaller or softer 
make. A very young baby may need a smaller sized 
catheter. This catheter is attached to a fountain syringe 
by means of the smallest tip that comes with the syringe, 
or better still a glass connecting tube. It is well greased 
with vaselin or oil and the syringe is hung about three 
feet above the child; it is usually filled with salt water — 
one teaspoonful of salt to each pint of boiled water is the 
correct proportion. From one to two quarts are generally 
needed. The temperature of the water when used may 
be from 60 to 104 or 105° according to the reason for 
the irrigation; usually about 98° F. is the best. If it is 
given to help reduce fever it may be used cold; if to 
stimulate a child who is cold it may be used hot. It is 
best given to the child on a table or other hard surface. 

The child is placed on his back on a rubber sheet on the 
top of which is a pad or several folded diapers ; his clothing 
is well drawn up under him and his legs are held up. The 
rubber sheet should drain into a large basin or tub so that 
the results of the irrigation may be observed; they should 
not be carelessly thrown away but saved to show the doctor 
when one is expected. If given in bed a bedpan may 
be used to catch the water, but the rubber sheet should 
be placed under the pan, for it is usually a very wet pro- 
ceeding unless given very carefully and neatly. The water 
should be shut off at first but as soon as the catheter has 



68 PECULIARITIES OF DISEASE IN CHILDREN 

been passed about one or two inches into the rectum it 
may be turned on and will keep the catheter stiff while it 
is being gently worked up; very often it is possible to get 
it up the whole length. No force should be used; if it 
doubles up it should be removed, the water turned off, and 
tried again. The abdomen may be very gently kneaded 
at times. 

When the water runs clear it is time to stop the irriga- 
tion as a rule, the water shut off and the catheter left in 
place but detached from the syringe. The abdomen being 
kneaded gently the water flows out of the catheter until 
the bowels are empty ; then the catheter should be rapidly 
drawn out and the parts dried. If for any reason it is 
thought advisable to leave some salt solution in the intes- 
tines after the bowels have been irrigated then at the 
end of the washing about six to eight ounces of the pure 
salt solution may be allowed to flow into the bowel while 
the buttocks are elevated by a pillow. After this is done, 
the catheter is pinched and drawn quickly out while the 
buttocks are held together and kept elevated for twenty 
minutes or even longer, so that the salt solution may 
be absorbed. 

This is helpful when the child is prostrated or hav- 
ing many stools in twenty-four hours and thus losing a 
great deal of water from the tissues. Some advocate 
this irrigation two or more times daily but I have found 
that it is usually too irritating to be done more than once 
in twenty-four hours. In a case of infected intestinal 
disease where the bowels are still full of the poisonous 
matter it is one of the best remedies we have, but if kept 
up too long or used too often in milder cases it is apt 



TKEATING DISEASE IN THE SICK CHILD 69 

to continue the passage of mucus rather than to relieve 
the conditions present. 

Stomach Washing 

This is used in cases of gastritis or severe vomiting or 
catarrh of the stomach ; also to empty the stomach quickly 
when poisonous substances have been swallowed. It should 
be done by a trained nurse or a doctor and not by a 
mother; so it need not be described in detail here. 

Suppositories 

These are often useful when the bowels must be helped 
a little and an enema is not thought advisable; they just 
start the bowel action as a rule. For very quick action 
a glycerin suppository is best but it should not be used 
often as it is too irritating; the small sized ones should 
be used for babies and young children. Sometimes they 
come in the form of a stick and may be inserted a short 
way and then withdrawn; others come small enough to 
be completely inserted into the rectum and then they 
are expelled with the fecal matter. 

Gluten Suppositories. — The gluten suppositories made 
by the Health Food Company and sometimes called 
"entona^^ are to be preferred for frequent use as they do 
not irritate. They take longer to act — sometimes an hour 
or more. They are to be inserted completely into the 
rectum and it is better to cover them with a little vaselin. 

Soap Suppositories. — The homemade soap stick is useful 

for training the baby to use his chair at a regular time each 

day. Pure white soap like Castile soap should be whittled 
6 



70 PECULIAEITIES OF DISEASE IN CHILDEEN 

smoothly about the size of one's little finger and then 
covered with oil or vaselin and inserted into the rectum 
about an inch^ just to give it the needed stimulus; it 
should then be withdrawn and the child held over the 
chair. Great care must be used not to injure the delicate 
lining of the intestines when employing any of these 
articles and as soon as possible their use should be dis- 
continued. 

Medicated Suppositories. — Medicated suppositories are 
sometimes ordered by the doctor for certain diseases but 
these are not very often used in infants or young children. 

Douches 

The vaginal douche and the nasal douche are some- 
times employed in infancy and childhood. The vaginal 
douche may be needed when a little girl has leukorrhea 
or gonorrhea. A saturated solution of boric acid, or any 
solution the doctor orderS;, should be placed in a fountain 
syringe and held about three feet above the child; it may 
be given on a bedpan or rubber sheet on a table. The 
smallest spray or nozzle that comes with the syringe should 
be used. The labia should be held open and the spray 
or douche allowed to flow over the parts and up as high 
as it will go naturally without any force until one pint 
or one quart has been used. The parts should then be 
carefully dried and powdered. Do not ever force the 
nozzle up into the delicate vagina. 

Nasal Douche and Throat Douche, — In cases where the 
child cannot blow the nose to free it thoroughly, or in 
cases where the usual spray cannot reach, the nasal douche 



TEEATING DISEASE IN THE SICK CHILD 71 

may become necessary. It must be used with great care, 
as sometimes fluids are forced into the tubes running into 
the ear and considerable harm may be done. A fountain 
syringe with a very small tip or a hard rubber or glass 
syringe having a soft rubber tip may be used; if the 
fountain syringe is used it should be hung only one or 
two feet above the child. 

The clothing should be covered by a rubber sheet;, then 
by a towel, and if one owns a pus basin this should be 




Fig. 9. — Nasal Syringe. (After Holt's "Diseases of Infancy 
and Childhood.") 

held SO as to catch the fluid as it comes back ; if not, a large 
cup or plenty of gauze or cotton that can be burnt will 
do as a substitute. If the child is well enough it is better 
for him to sit up straight in the mother^s or nurse's lap 
while this nasal douche is being given, with his head bent 
a little forward ; if he is too ill to be taken from bed then 
he must be turned on his side and the head bent a little 
forward. Either a saturated solution of boric acid or a 
mild salt solution may be used in the douche. 

Personally I do not recommend this method of treat- 
ment unless a trained nurse is at hand to give it. If 
the mother undertakes this a medical person should give 
her an object lesson first and someone will always have 
to assist her. 



72 PECULIARITIES OE DISEASE IN CHILDREN 

The throat and mouth douches are given the same way 
and are usually attended with considerable difficulty, but 
are sometimes needed. The long nozzled, hard rubber 
syringe is the best usually to employ for the mouth and 
throat douche as it does no harm if the child bites the 
hard tip and it also acts as a tongue depressor. In bad 
cases of stomatitis or ulcers in the mouth and throat and 
occasionally in diphtheria this treatment may be helpful. 

Spraying the Nose and Throat 

This may often be needed as children do not blow the 
nose well. Eor the nose I like a mild oil substance like 
liquid albolene; to this menthol;, ichthyol, or any other 




Fig. 10. Albolene Atomizer. (After Holt's **Diseases of In- 
fancy and Childhood.") 



substance specially indicated may be added. An oil atom- 
izer should be used, and if the mother goes about it in 
the right way and does not make the child think he is to 
be pitied there is very little trouble. The bulb should 



TKEATING DISEASE IN THE SICK CHILD 73 

be squeezed three or four times for each nostril and it 
may be used every three hours if it seems to help. In 
cases of acute cold or where there are dry crusts in the 
nostrils this treatment is quite beneficial. 

The throat spray is a different kind of apparatus ; usually 
it has a long metal or rubber nozzle. I like the metal 
kind best as it is not harmed by boiling and lasts longer. 




Fig. 11. — Throat Atomizer. (Courtesy of Whitall Tatum Co., 

New York.) 



Boric acid;, bicarbonate of soda^ or salt solution^ may be 
used in the throat spray or any one of the mild disin- 
fectantS;, like borolyptol^, glycothymolin^, etc. For a sore 
throat, or to use as a precaution on dusty and windy 
days, the throat spray is very useful; it is especially so 
when a child cannot gargle. If possible the fluid used 
should be expectorated but if not the little swallowed will 
usually do no harm if it is one of the above-mentioned* 
solutions. 

Irrigation of the Eye 

It is usually best to use a special blunt or rounded-end 
eye dropper for this purpose; sometimes in mild eye affec- 
tions pieces of cotton will answer. Always use separate 



74 PECULIARITIES OF DISEASE IN CHILDREN 

pieces of cotton for each eye and cover np one eye while 
the other one is being irrigated. A solution of boric acid, 
one teaspoonful to one pint of boiled water, is generally 
used for this purpose. The lids should be held gently 
opened with thumb and finger of one hand while the 
eye is flushed with the solution in the dropper or cotton. 

Irrigation of the Ear 

To syringe the ear a soft rubber bulb syringe is the 
only thing that is safe for a mother to use. A small pus 
basin or a cup may be held under the ear to catch the 
solution. The child should sit in someone's lap and have 
his head firmly held against that person's chest; the tip 
of the ear should then be drawn upward and backward 
a little so as to straighten out the canal ; then warm boric 
acid solution, at a temperature of 100° — and made one 
teaspoonful to one pint of boiled water, should be used in 
the syringe. The tip of the syringe should be moved 
about so that all parts of the canal are reached and not 
held steadily in the center; the bulb should usually be 
filled two or three times. If the child is old enough to 
complain of being dizzy and this symptom is noted the 
syringing should then be stopped. After the ear is 
syringed it should be very carefully dried with cotton. 

Inhalations 

These are invaluable in treating infants and young 
children; whenever possible they should be tried first 
before medicines are given. In laryngitis, croup, bron- 
chitis, pneumonia, and some other affections of the breath- 



TEEATING DISEASE IN THE SICK CHILD 75 

ing apparatus they are used a great deal by physicians 
who understand the treatment of children. 

The most effectual way to give these inhalations is under 




Fig. 12. — Crib Prepared for Steam Inhalation. (After Ker- 
ley's "Short Talks with Young Mothers," published by G. P. 
Putnam's Sons, New York and London.) 



a tent. A large sheet may be thrown over the crib or the 
child may lie on a bed under an open umbrella over which 
the sheet is draped to form a tent. A baby carriage with 
the hood or parasol up and a sheet draped over this is 



76 PECULIAEITIES OF DISEASE IN CHILDEEN 

often handy to use. This may be pushed right out into 
the kitchen and the inhalation given there if more con- 
venient. 

The best kind of steam inhaler to use is a regular croup 
kettle with a long nozzle, and in vrhich there is a place 
to put a sponge on which any medicine prescribed may 
be dropped. If there is electricity in the house, the croup 
kettle may be most safely placed on an electric stove, but 
if not, a small gas stove or in cases of great need an 
alcohol or oil lamp or stove may be used. If the latter 
are employed the greatest care must be taken to sit by 
the child every minute the inhalation is being given and 
watch the lamp closely to see that the flame does not flare 
out and catch fire to the sheet. If the cook stove is a low 
one and nothing better can be had the kettle may be 
boiled on that. 

When one cannot get a regular croup kettle then a 
cheap tea kettle from the five and ten cent store may 
be used and heavy paper or cardboard may be tied or 
fastened in some way onto the spout so as to elongate it 
sufficiently to reach under the sheet. If the baby is young 
his hands should be bound to his sides by fastening a 
diaper or towel loosely but securely around him, other- 
wise he may throw them directly in the way of the hot 
steam and become burnt. Never leave the child alone while 
the inhalation is being given. 

If a regular croup kettle with a sponge for the medi- 
cine to be inhaled is used then a few drops of the fluid 
may be sprinkled on the damp sponge, but if there is no 
sponge attached then about one teaspoonful of the medica- 
tion to one pint of boilmg water is the general proportion. 



TEEATING DISEASE IN THE SICK CHILD 77 

Boiling water should be added constantly as the first boils 
away. 

Compound tincture of benzoin is one of the most fre- 
quently used medicines for inhalations. Creosote, oil of 
pine needles, and eucalyptol are sometimes used, but if the 
mother is giving the inhalation without special orders 
from her doctor she had better keep to the benzoin. 

The child may remain under the tent for from ten 
to twenty minutes according to the manner in which it 
affects him. If the relief is great the inhalations may be 
repeated every two or three hours. If not they should be 
given only two or three times daily. For severe croup 
cases, they may steadily be continued until the breathing 
is relieved. There are a few children who cannot seem 
to stand inhalations; if they become pale or blue or seem 
very weak then the inhalations must be stopped at once, 
but this is the great exception to the general rule. 

A child of six years or older may sometimes be allowed 
to have the inhalations from a pitcher of boiling water 
held in the mother's lap or on a low table. A towel 
should be thrown over the child's head and over the pitcher 
also and he should open his mouth and inhale the steam 
for ten or fifteen minutes if possible. The kettle method 
is much to be preferred, however. 

Massage 

In infants this is not used to any great extent. Cases 
of constipation may be helped by this sometimes, especially 
when used in connection with other methods of correcting 
the disease. The best method is to use a little olive oil 



78 PECULIAKITIES OF DISEASE IN CHILDREN 

or cocoa butter on the ends of one^s fingers and then 
begin at the right groin rnbbing the deeper parts of the 
abdomen with a circular movement^ the fingers not moving 
on the skin^ making a series of small circles and gradually 
working up to the ribs, then across and down on the left 
side. This should be kept up for five or ten minutes at 
some regular time twice daily but not directly after a 
meal. The stroking method is sometimes used but I 
think this way is more effectual. Cases of birth paralysis 
and later on other forms of paralysis may be benefited by 
massage, but to give it correctly a medical person must 
personally instruct the mother first. 

Babies with poor nutrition or circulation are often 
helped by rubbing with some warm oil like melted cocoa 
butter or olive oil. I do not advise cod-liver oil. After 
the warm sponge or tub bath the child is placed on a warm 
blanket in front of the fire and rubbed with the mother's 
hand on which the oil is placed. The part of the body 
not being rubbed at that time should be covered. The 
rubbing should be continued for fifteen or twenty minutes. 

Older children who require massage for any special 
purpose are treated as in the case of adults, only more 
gently at first, and a trained masseuse or the family doctor 
should give the mother an object lesson to secure the best 
results. 

Mercurial ointment is sometimes used for babies and 
children who have inherited syphilis and occasionally for 
other troubles. The prescribed amount should be used 
on the tip of the finger and then very thoroughly rubbed 
into the part indicated. Generally it is given on opposite 
sides of the body on different days. The armpit and groin 



TEEATING DISEASE IN THE SICK CHILD 79 

should receive special attention as the ointment is easily 
absorbed in these places. For example an arm and under 
the arm is selected one day^ the other arm the next day, 
then the leg and groin on one side, then the other leg, and 
finally the abdomen. When the body has been gone over 
thus, one commences all over again. Care should be taken 
to wash one^s hands very carefully after giving such an 
inunction. 

ELECTRiaTY 

In cases of birth paralysis and infantile paralysis and 
some other types, electricity is sometimes quite helpful. 
The faradic current should be tried first and only when 
this proves useless should the galvanic current be used. 
Electricity should always he ordered by a doctor and the 
first application at least should be made by him. If he 
then thinks it safe he may personally teach the mother 
by an object lesson exactly how to use the battery. 

Change of Climate 

Here we have one of the most valuable means of restor- 
ing a baby and young child to health. In cases of anemia, 
malnutrition, rickets, tuberculosis, influenza or grippe, 
asthma, hay fever, whooping-cough, summer diarrhea, and 
to build up a child after any prolonged illness a change 
of air will often work wonders. 

In cases of influenza or grippe, where a very high tem- 
perature has been run for some time and which will 
not yield to any other treatment a complete change of air 
will bring down the temperature in a very short time in 
a great many cases. Whether this change of air shall 



80 PECULIARITIES OF DISEASE IN CHILDREN 

be in the country^ mountains, or seashore, depends on the 
habitual residence of the patient and many other condi- 
tions which can only be determined in each individual 
case. Usually, however, children living near the sea, as 
in New York or Boston, do better when taken to the 
mountains or inland country; the change is more com- 
plete. Patients living in the North where the winters 
are very long and cold are often much benefited by a 
change to warm Southern air; especially is this true in 
cases of rheumatism and asthma. 

High, dry air is helpful to tubercular cases in many 
instances. Young babies and children usually do better 
in high dry air that is at least moderately warm than in 
the very cold places, but older children stand the cold 
well if it is a dry cold. Dry cold and dry heat are 
much better than the same temperatures when there is 
much moisture or humidity in the air. It is not always 
possible to try this method of treatment but whenever 
it is, every effort should be made to do so as it will usually 
prove more helpful in building up a little patient than 
quarts of tonics, etc., which are apt to upset the stomach 
if given for too long a time, iltlantic City and Lakewood 
are the resorts most sought by persons living near enough. 
In winter I usually prefer Lakewood for babies under 
two years of age at least, as the high winds of Atlantic 
City are too vigorous for the young babies; older chil- 
dren usually do well at Atlantic City especially in the 
spring and fall; Florida is usually very helpful to young 
and delicate babies who need to live out of doors and can- 
not do so unless the climate is very mild. In summer the 
Adirondacks are beneficial to babies and children of almost 



TEEATING DISEASE IN THE SICK CHILD 81 

all ages. Children with hay fever or rose colds usually 
do better in a city than in the country where the hay 
and pollen from the flowers aggravate the disease. Each 
case, however, differs and must be studied carefully. 



CHAPTER III 
CARE OF PREMATURE AND DELICATE INFANTS 

A PREMATURE infant is a baby who is born before the 
ninth month or two hundred and eighty days — the time al- 
lotted for carrying a normal infant. Babies born during 
the seventh or eighth month have a fair chance of surviv- 
ing if they are wisely cared for^ bnt those born before this 
time rarely live. 

In deciding whether a baby is premature we must care- 
fully consider its general appearance^ its hair^ nails^ weight, 
and, most important of all, its length. When we find a 
baby measuring less than nineteen inches we can be 
almost certain it is premature. Premature babies, weigh- 
ing three or four pounds, generally survive, and cases 
weighing two or even a little less have been known to 
grow up but they are very rare. 

In the care of a premature infant there are two points 
that must be constantly kept in mind: uniform warmth 
and suitable nourishment. The organs of circulation and 
respiration are not, as a rule, fully developed in these 
tiny babies ; therefore they have not enough "animal heat^^ 
or vitality to keep themselves warm ; a sudden chill to such 
a baby may cost it its life. During the process of delivery 
the room must be warm and no drafts be allowed to strike 
the child. 

82 



UNIFORM WARMTH 



UNIFORM WARMTH 

The moment the baby enters the world it should be 
covered with a warmed blanket^ and as soon as the cord 
is cut the baby must be placed in a warm basket and sur- 
rounded by hot water bags. Whoever handles these tiny 
strangers must have warm hands: a cold hand is .quite 
enough to cause decided chill. The eyes of baby should be 
washed with a saturated solution of boric acid and this 
should be used lukewarm; or if the doctor thinks best 
he will often use a few drops of a one or two per cent, 
solution of silver nitrate or one of the numerous silver 
preparations now on the market. 

When it is time to give the premature baby its first' 
bath it is best to use warm olive oil in place of water. 
The bath should be given in front of an open fire if pos- 
siblo;, the baby lying on one warm blanket and covered 
with another small one. Most of the bathing can be easily 
done by placing the hand under the blanket or carefully 
lifting up one corner of it at a time; under no circum- 
stances must a draft be allowed to strike the baby. The 
cord should be wrapped in a small square of sterile gauze 
or soft linen and held in place by means of a broad fiannel 
binder which has been warmed first. A soft diaper of gauze 
or even absorbent cotton is best to use in these cases ; the 
baby may then be wrapped in cotton batting, covering the 
entire body, arms, and legs, or else it may be put into a 
warm flannel gown made like a bag and having no sleeves. 
If this bag is used it must be of wool flannel and not outing 
flannel. Outing flannel, being cotton, does not retain heat 
as well as real wool flannel. I have a slight preference for 



84 PEEMATUEE AND DELICATE INFANTS 

the cotton batting because it can be made to fit closer to the 
body. A cotton suit made all in one piece is best of all. 

When this cotton garment is used an incubator or an 
especially warm room is not needed. The baby in its 
cotton garment is simply placed in a basket, with two hot 
water bags near it and a light wool blanket thrown over 
it. Plenty of pure, fresh air can then be admitted to the 




Fig. 13. — Premature Suit. 



nursery, so that the baby breathes an atmosphere full of 
oxygen and still is warm enough to maintain a normal 
temperature. 

The little garment has been found of so much value to 
a number of mothers and nurses that the idea is passed 
on, hoping it may thus save other little lives. 

The garment is made from cheesecloth and is cut all 
in one piece. It has cotton basted inside of it, either 
one or more layers of the cotton being used as seems 
desirable for the special baby. As the baby becomes 
stronger the layers of cotton are gradually removed, until 



UNIFOEM WAKMTH 85 

one thin layer is left; then the baby is ready for real 
clothing. The little cap, mittens, and diaper are separate 
pieces. As the garment is changed only every other day 
it is basted onto the baby. The diaper and cap are 
simply laid on, and may be changed as often as needed. 

The garment may be basted up the back or in the 
front, either way one prefers. It is usually a little more 
convenient to baste it in the front. 

Incubators are sometimes used for premature babies 
but I have never found them very successful because it is 
almost impossible to giYe the child enough fresh air and 
at the same time keep it warm enough in one of these 
contrivances. A clothes basket, in the bottom of which 
are three hot water bags, then a warm, folded blanket, and 
smaller blankets covering the sides, make the best bed 
for the baby. When the child is placed in the basket an- 
other light wool blanket should cover it and outside of 
this, one or two hot water bags. Still another blanket 
may be thrown over the entire basket with the exception 
of a small space near the head which must be left open for 
ventilation and entrance of fresh air. A thermometer 
must be tied inside the basket and kept at a temperature 
of 90° F. for the first few days at least. If kept too warm 
the baby is apt to develop a ^^hot water bag temperature'' ; 
the rectal temperature going as high as 104° to 105° F. 
in some cases. 

The basket should be placed on a table in the center of 
the room where there is a good circulation of fresh air, but 
it may be partly surrounded by screens. It is a great 
mistake to tuck such a baby away in a corner of the 
room or in front of a reo;'ister where the air is bad and 



86 PREMATUEE AND DELICATE INFANTS 

does not have a chance to change frequently. A careful 
i^atch must be kept on the hot water bags and when it 
is necessary to change one it is well to have another hot 
one on hand to be slipped in its place. An electric pad 
is very much less trouble than hot water bags or bottles 
^nd also preserves a more uniform heat, but to employ 
these pads there must be electricity in the house. The 
temperature of the room in which the baby is kept need 
not be over 70° F. and it is absolutely essential to have 
ihe air fresh and pure. 

NOURISHMENT 

The question of nourishing premature babies is often 
a difficult one to solve. Breast milk is far the best food 
if it can possibly be obtained. As the mother of a pre- 
mature baby is not apt to have much milk a wetnurse 
will often have to be employed. When such a nurse is 
engaged it will be found best for many reasons to take 
her own baby also; the premature child will not be able 
to use all the nurse's milk and her own baby will be 
needed to draw the remainder; if a breast pump is used 
for this purpose it may cause the milk to dry up. The 
nurse's baby can easily be given a bottle of modified milk 
one time and his mother's milk the next so that there 
will be plenty for both babies. Sometimes the premature 
haby will be too weak at first to draw the milk from the 
hreast; in such cases it will be necessary to use the breast 
pump, depending upon the nurse's own baby to keep up 
the flow. It will often be necessary to dilute the breast 
milk a little with water or possibly Vichy at first. 



NOUKISHMENT 



87 



The milk may be fed to the premature infant by means 
of a droppei;, or much better^ a ^'^Breck Feeder/^ This 
little article is simply a glass tube with a rubber bulb 
on one end and a tiny rubber nipple on the other. The 




1-8 



1MI 



Fig. 14. — Breck's Feeding Tube. (After Holt's 
Infancy and Childhood.") 



'Diseases of 



nipple is placed in the baby's mouth, and he draws on 
it as much as he is able, while mother or nurse helps him 
by gently squeezing the rubber bulb on the other end. 
Many babies have been taught to nurse in this way and 
as they grow stronger very little assistance need be given. 



88 PKEMATUKE AND DELICATE INFANTS 

tmtil finally they can use a regular nursing-bottle or take 
the milk from the breast itself. Great care must be 
taken to keep the milk that is drawn from the breast 
warm enough. This may be done by placing the bulb 
of the breast pump, in which the milk is drawn, in hot 
water and then pouring it a little at a time into the 
glass tube of the feeder which has previously been 
warmed. 

The amount of food given to a premature baby depends 
altogether upon its size ; some very small and feeble infants 
will not be able to take more than one teaspoonful at a 
time and will have to be fed every hour with a little 
stimulant in between, while others can take an ounce of 
food every hour and a half or two hours. 

When breast milk is impossible to obtain either from 
the mother or from a wetnurse, modified milk must be 
resorted to. A weak formula must be used at first and a 
very gradual increase in strength made as the baby^s di- 
gestive organs grow stronger. It is often a good plan 
to wholly or partially peptonize the milk for a few days 
at least, as the infant needs this help. A formula suitable 
to start many premature babies on is made up as follows : 

Formula for Modified Milk 

From a quart bottle of fresh milk remove, with a dipper, the 
top sixteen ounces; of this top milk take one ounce, add to it 
nine ounces of boiled water, one-half ounce of lime water, two 
teaspoonfuls (level) of milk sugar or three of malt sugar. If 
this is to be peptonized the lime water should be omitted and 
Fairchild's peptonizing tubes used as directed. If this food is 
well digested then gradually work up to the regular modified 
milk formulas {see page 22) and little by little, shorten the 



NOURISHMENT 89 



time of peptonizing until this process can be entirely done away 
with. 

Sometimes these infants are too weak to swallow and 
in such cases the only thing to do is to give the food and 
stimulants by means of gavage. This apparatus consists 
of a small rubber catheter (12 to 16 American scale )^ a 
rubber connecting tube^ and a glass funnel. The catheter 
is dipped in a little warm olive oil, then gently pushed 
down the baby^s throat, through the esophagus and into 
the stomach ; the warm milk is then poured into the funnel 
and allowed to run down the tube. As soon as the funnel 
is empty the catheter is tightly pinched and very quickly 
drawn up. When this method of feeding is not necessary 
all the time, it is often advisable to use it two or three 
times a day and let the baby take a bottle or the breast 
the rest of the time. If a mother is to use this method 
herself, she must be carefully taught by her physician or 
trained nurse. 

Premature babies need plenty of water to flush their 
kidneys. They should be given at least two teaspoonfuls 
between each feeding ; this water must be boiled and given 
warm and if the baby needs stimulants they may be 
given in the water. If the water is given by a medicine 
dropper, introduce the dropper way back into the mouth 
so that the fluid falls on the back of the tongue; in this 
way the child will swallow better and lose less of the 
w^ater. 

Another method of nourishing a premature infant is 
through its skin; the daily oil bath that it receives is 
also a slight means of nourishment if the oil is well rubbed 



90 PEEMATTJEE AND DELICATE INFANTS 

into the skin. Cocoa butter may also be used for this 
purpose. No great amount of nourishment can be de- 
pended upon by these inunctions however ; they are simply 
an adjunct to the other means of nourishment. 

Premature babies are exceedingly apt to be constipated 
and even when the movement itself is soft they often have 
not the strength to expel it;, the muscles of the rectum are 
so weak. The intestines must be cleared out at least once 
a day, and to do this either an injection of one ounce 
of olive oil may be given by means of a soft rubber bulb 
syringe or a small, soft rubber catheter may be gently 
worked up into the lower bowel and the intestines flushed 
with sterile water or salt water. An ordinary fountain 
syringe to which the catheter is attached is a convenient 
apparatus to employ; from six to eight ounces of water or 
salt solution is enough to use. By using the injection at 
the same time every day the baby's bowels may be gradually 
trained to move by themselves. A premature baby who 
indulges in a good cry every day is much more hopeful 
than one who has to be made to cry and then only has 
a feeble whine. A baby should not be stopped from 
crying unless he has a decided cry of pain; ho needs this 
cry very much to expand his lungs. 

It is not wise to weigh these premature babies more 
than twice a week; they are so apt to get chilled in the 
process. When they are weighed it must be done while 
the cotton or flannel bag is on the baby, and a warm 
blanket is in the scales and over the child; then when 
he has his oil bath all these things may be removed and 
weighed and their weight subtracted from the total weight 
when baby's actual weight will be learned. Very often 



NOUEISHMENT 91 



these tiny babies will not gain at first but it is a bad 
symptom if they lose in weight steadily. 

As the premature baby grows older and gains in strength 
and vigor he may be allowed to take a short airing in 
the sun with the window lowered a few inches; and the 
time and amount of air may be increased a little every 
day^ until he can at last be taken out of doors if well 
wrapped. Drafts should always be avoided, however, both 
in the house and out of doors. 

Babies not premature, but who are small and delicate 
from other causes, should be treated in the same manner. 



CHAPTEE IV 

MOST COMMON DISEASES OF THE ORGANS OF 
DIGESTION 



DISEASES OF THE MOUTH 
Herpes — Fever ob Cold Sores 

Causes. — Herpes of the lips is a disease known to most 
people by the common name of "fever sore^^ or "cold sore/^ 
It usually occurs where there has been some fever but 
may appear without any other marked symptoms. 

Treatment, — Children are so apt to pick the sore lips or 
suck them that it is often difficult to cure these sores. A 
dusting powder of equal parts of burnt alum and bismuth 
should be applied to the sore several times a day after 
it has been washed with boric acid solution. Another good 
thing to use is a paste called ^T)assorin paste'^ ; this may be 
difficult to procure^ however^ in any but large cities. If 
the child persists in picking the sore^ cotton bags or thumb- 
less mittens should be placed on his hands because the sore 
will not heal unless it is left alone. 

Little Ulcers 

Treatment. — Little ulcers in the corners or angles of 
the mouth are not infrequently seen. A mouthwash of 

92 



DISEASES OF THE MOUTH 93 

saturated solution of boric acid and burnt alum and bis- 
muth powder mixed in equal parts should be tried, but if 
these remedies do not heal the ulcer it should be touched 
with a silver nitrate pencil and then the powder applied. 

Various cracks and fissures sometimes seen in the lips 
should be treated by the same methods. 

Ulcers of the Tongue 

Caitse. — An infant who has cut his lower incisor teeth, 
may sometimes have a little ulcer under his tongue. This 
is caused by friction on the mucous membrane by the 
teeth while the baby is nursing from the breast or 
bottle. 

Treatment. — The tongue should be gently lifted and the 
ulcer washed with boric acid, then touched with silver 
nitrate and the burnt alum and bismuth mentioned above 
dusted on. If the ulcer is a deep one and will not heal 
the baby may be fed by a dropper or a spoon for a day 
or two, so that he will not need to suck. 

Red Patches on the Tongue 

Cause. — Eed patches surrounded by a gray border are 
sometimes seen on the tongue ; they often last a long time 
and their cause is not fully known at present. 

Treatment. — They require no especial treatment other 
than keeping the mouth clean with a mouthwash like boric 
acid. 

Geographical Tongue 

The condition commonly known as geographical tongue 



94 DISEASES OF THE OEGANS OF DIGESTION 

is very similar; the margin of the tongue here is red and 
the center gray or white ; an irregular wavy line separates 
these two portions and looks much like the outline of a 
map — hence its name. 

Painful Teething 

There is no doubt that babies often suffer a good deal 
from the cutting of teeth. The intense congestion and 
swelling of the gums is necessarily painful at times and 
causes more or less restlessness. Not infrequently there 
is fever and even some vomiting or green, undigested 
stools. 

Treatment. — A cooling mouthwash, such as borolyptol 
diluted with equal parts of cold water, may be rubbed on 
the inflamed gums and frequent drinks of cool water given 
to the baby. When the tooth is near the surface it may 
often be rubbed through. To do this place a piece af 
sterile gauze on your finger and firmly rub the membrane 
over the tooth ; when the edge is felt through the gum wash 
it with boric acid frequently, so that the gum will not 
become infected while there is a raw surface. 

If there is great restlessness, fever, or any signs of a 
convulsion, a physician should be asked to see the child 
and lance the gum. This will at least let out some of the 
throbbing blood, relieving the congestion and so easing 
the pain. It is best not to give the baby hard rings, rattles, 
etc., to bite on; they often harden the gum and may not 
be clean. 

When signs of indigestion from teething are noticed 
they should be treated just as at other times. A dose 



DISEASES OF THE MOUTH 95 

of castor oil should be given, the food weakened in 
strength, or simply barley water given for a few feed- 
ings, until vomiting has ceased or the stools are again 
normal. 

Care should be exerted not to tax the digestion of a 
teething baby, either breast-fed or bottle-fed. A breast- 
fed baby may have the milk diluted by giving him an 
ounce of boiled water or barley water just before each 
nursing, then allowing him to have the breast for five 
or ten minutes only. For twitching and nervous symptoms, 
in addition to above treatment, a bag should be filled with 
finely cracked ice and kept on the baby^s head; he should 
be kept absolutely quiet and disturbed as little as possible. 
An enema of soap and water will often relieve the nervous 
symptoms by quickly emptying the bowels. When there 
is fever and restlessness a sponge bath of a basin of tepid 
water and two tablespoonfuls of alcohol will many times 
prove very gratifying and induce the child to fall into a 
refreshing sleep. 

Every ill should not be attributed to ^^only teething,'^ 
but the teeth should be borne in mind as a possible cause 
of the disturbance. 

Stomatitis 

Causes. — This condition may be caused by injury or by 
heat, as taking food that is too warm, or it may accom- 
pany the infectious diseases. This is an inflammation of 
the mouth. We meet with several kinds of stomatitis: 
the simple or catarrhal variety, the aphthous, ulcerative, 
thrush, gangrenous, and the varieties that occur with some 
of the infectious diseases. 



96 DISEASES OF THE OKGANS OF DIGESTION 

Simple or Catarrhal Stomatitis 

Symptoms. — In the case of simple or catarrhal stomatitis 
"^e see swelling and increased redness of the lining mem- 
brane of the month with abundant saliva. The month 
is hot and there may be some general temperature; the 
baby is fretfnl^ and he evidently does not care to eat on 
account of the pain caused by so doing. There may evea 
be some vomiting or diarrhea. 

Treatment, — To cool the hot mouthy ice may be given 
to suck and the cooling mouthwashes mentioned (see p. 
7) should be freely used. If the food is absolutely refused 
it may be given to young babies by gavage^, a description 
of which will be found on page 89. 

Aphthous Stomatitis — CanTcer Sores 

Symptoms. — In aphthous stomatitis or ^^canker sore 
moutlf ^ we see small^ yellowish, white spots scattered over 
the inner surface of the mouth; they soon turn into tiny 
superficial ulcers. The disease usually lasts from five days 
to two weeks. The ulcers frequently come in crops; they 
are most numerous at the border of the tongue and inside 
of the lips. The other symptoms are the same as in simple 
stomatitis. 

Treatment. — The treatment is the same as in simple 
stomatitis, except that the little ulcers should each be 
touched with a little powdered burnt alum. The alum 
may be applied by means of a swab, made by firmly twist- 
ing a tiny piece of cotton on the end of a wooden tooth- 
pick, then dipping this in the powder and gently touching 
each ulcer. 



DISEASES OF THE MOUTH 97 

Ulcerative Stomatitis 

Causes, — Ulcerative stomatitis is not found unless the 
child has teeth. It begins where the teeth meet the gum 
and extends along them and to other parts of the mouth. 
Lack of cleanliness in care of the mouth and teeth, poor 
nutrition, .and any general "rundown^' state of health may 
cause this form of stomatitis. 

Symptoms. — One of the most marked symptoms here is 
the very foul breath of the sufferer. The saliva often 
pours from the mouth, the swollen and spongy gums will 
frequently bleed if touched, and the distinct line of ulcers 
will usually loosen the teeth, which will fall out. Fever, 
pain, and a generally miserable condition accompany this 
trouble. It sometimes yields promptly to the following 
treatment but may last for months if the patient^s general 
health is much below par. 

Treatment. — ^Chlorate of potash given internally is the 
treatment above everything else in these cases. The sat- 
urated solution is generally given — one-half teaspoonful 
every two hours. This is best given in a tablespoonful of 
water. The medicine may be gradually reduced in amounf 
and frequency as the mouth improves, and often entirely 
stopped by the end of a week. The local treatment should 
consist in syringing the mouth with a saturated solution 
of boric acid, or one of the antiseptic mouthwashes. This 
should be done every hour if the case is a severe one. Be- 
sides this the ulcers should be touched with silver nitrate 
and the burnt alum and bismuth in equal parts then 
duyted on. I have found the following astringent mouth- 
wash most helpful in these cases. 



98 DISEASES OF THE ORGANS OF DIGESTION 

Formula for Mouthwash 

Tincture of myrrh, one drachm. 
Tannic acid, one-half a drachm. 
Glycerin, one-half ounce. 
Water, four ounces. 

The mouthwash is used three or four times daily and 
applied to the sore parts by means of a swab of absorbent 
cotton. Plenty of fruit and fresh^ green vegetables should 
be given such a child;, and later an iron tonic is generally 
needed. A doctor should have charge of the child until 
the mouth is entirely healed. 

Thrush or Sprue 

Causes. — Thrush or sprue is a disease known to nearly 
all mothers; it is caused by a little parasite and is most 
often due to lack of cleanliness in care of the baby's mouth 
or his bottles and nipples. It is much more apt to occur 
in poorly nourished children whose vitality is not quite 
up to the mark. 

Symptoms, — The small;, white specks or flakes seen on 
the tongue, inner surface of the lips and cheeks, as well 
as on the roof of the mouth and as far down the throat as 
one can see, resemble particles of milk, but unlike them, 
they cannot be wiped off. These little patches often join 
one another and form quite an extensive membrane. The 
baby's mouth is generally dry and there is difficulty in 
taking food and swallowing when the disease is well ad- 
vanced. 

Prevention and Treatment. — The most careful attention 
should be paid to the baby's nursing-bottle and the cleanli- 



DISEASES OF THE PHAEYNX 99 

ness of the rubber nipples. If he has been in the habit 
of using a ^^pacifier'^ this must at once be burned^, never 
to be replaced, as it is often the cause of this disease. 

The mouth should be carefully washed with a saturated 
solution of boric acid three times daily; and every hour, 
in severe cases, with a solution of bicarbonate of soda, 
using one teaspoonful of the soda to one cup of boiled 
water. Later it will be found that after each meal will 
be sufficiently often to use this. In washing the mouth a 
piece of absorbent cotton should be firmly twisted around 
the little finger, dipped in the solution and then gently 
applied to all parts of the sore mouth. If the mouth is 
scrubbed or treated roughly more harm than good is done. 
Never under any circumstances should anything very sweet 
be used in treating this trouble ; honey and borax, so often 
advised by the old-fashioned nurse, are about the worst 
remedies that could be used. 

DISEASES OF THE PHARYNX 
Acute Pharyngitis or ''Sore Throat'' 

The pharynx is the tube that leads into the esophagus 
and hence into the stomach ; so it may be classified as part 
of the alimentary tract. 

Acute inflammation of the pharynx or pharyngitis may 
be a disease by itself, or may be associated with other dis- 
eases. Especially does it occur with measles, influenza. 
scarlet fever and diphtheria. 

Causes. — Acute primary pharyngitis may be caused by 
exposure to cold and wet, or to high winds which carry 
the filth of street dust, or to indie^estion. A common cold 



100 DISEASES OF THE OEGANS OF DIGESTION 

often begins with pharyngitis^ the child complaining of a 
^^sore throat/^ Children who are mouth breathers, having 
adenoids, are very prone to this trouble as are also those 
who have been too warmly clad and treated like hot-house 
plants. Some physicians think that rheumatism or uric 
acid in the system is the explanation of repeated attacks 
of acute pharyngitis. 

Symptoms. — There is usually inflammation of the parts 
higher up, as the nose and a part called the nasopharynx. 

Looking into the throat, it will be found bright red and 
many times very dry, while at others a coating of mucus 
may be seen there. There is often a slight swelling of 
the glands on the outside of the throat ; there is some pain 
and difl&culty in swallowing and there may be quite high 
fever. In the mild cases, there is very little elevation of 
temperature. The child will feel more or less languid and 
cross and may have an irritating cough. 

Duration. — The disease by itself rarely lasts more than 
three or four days but if the process extends into the 
larynx or bronchial tubes it lasts much longer and is 
more serious and troublesome. 

Treatment. — Because of the liability of pharyngitis to 
precede or accompany the contagious diseases, it is always 
best when possible to keep the child by himself if there 
are other children in the family. While this may be some 
additional trouble to the mother, she will be repaid a 
thousandfold should the patient develop a contagious dis- 
ease and the other members of the family escape it be- 
cause of her careful forethought. The patient should not 
be allowed to go out of doors and should be kept in bed 
if there is even a slight fever. 



DISEASES OF THE PHARYNX 101 

The first thing to be done in the way of medicine is 
to open the bowels freely. Calomel, castor oil, or 
magnesia may be used. The citrate of magnesia is 
pleasant to take and I often prescribe it. For a child of 
two years one ounce given every hour for three or four 
doses is correct; a child eight years of age or over may 
be given a glassful before breakfast. If there is high 
fever, alcohol sponge baths will do much to make the 
patient comfortable. Cold applications to the outside 
of the throat will often be helpful. A compress wrung 
out of equal parts of witch hazel and water, or alcohol 
diluted four times with water, is best to use. To protect 
the nightdress from getting wet, a little piece of oil silk 
may be basted around the collar; this is better than plac- 
ing it outside of the wet compress because in this way it 
does not prevent evaporation of the cooling fluid and when 
the evaporation can go on the child's throat will be cooler 
and the inflammation more quickly allayed. 

If the patient is old enough he should be made to gargle 
every two or three hours with boric acid solution, or 
borolyptol one part, water three parts. When the child 
cannot gargle the solutions may be put in a throat atomizer 
and the throat sprayed. Every child should be taught 
to gargle by the time he is five or six years old at the 
latest. 

If a doctor is not in attendance the mother must place 
the child in a good light and make a careful examination 
of the throat every day; the tongue may be held down 
by a spoon handle so that all parts of the throat can be 
seen. At the first sign of white spots in the throat a 
doctor must be summoned, as diphtheria may be develop- 



102 DISEASES OF THE ORGANS OF DIGESTION 

ing. The mother should also carefully examine the child's 
body for a rash two or three times a day^ remembering 
that the sore throat may be only the onset of measles or 
scarlet fever. 

Diet, — The diet should be lights such as milk^ broths^ 
junket, or wine jelly, and most gratifying of all to the 
dry little throat is ice cream, — the simple, vanilla, home- 
made variety is the best. Pieces of cracked ice may be 
given the child to hold in his mouth and swallowed slowly, 
and frequent drinks of cool water should be given. 



CHAPTER V 

MOST COMMON DISEASES OF THE ORGANS OF 
DIGESTION (Continued) 

MOST COMMON DISEASES OF THE STOMACH AND 
INTESTINES 

Vomiting or Acute Gastric Indigestion 

Vomiting is a very common disorder in babies and 
young children but it must never be looked upon as nor- 
mal. Old-fashioned nurses often tell a young mother that 
vomiting is a sign of a healthy baby^ but this is not so. 
When a baby vomits^, something is wrong either with the 
food or with the child itself and every effort must be 
made to ascertain the cause and cure it. 

Causes and Symptoms. — When a baby is over-fed either 
from the breast or bottle or irregularly fed, he will in- 
variably vomit and this occurs almost directly after a 
meal^ the milk looking about the same as it did before 
it was taken. In such cases a smaller quantity should 
be given at a time with a longer interval between meals; 
if the smaller quantity alone does not stop the trouble, 
absolute regularity must be observed. A nursing baby 
should be weighed just before and just after nursing to 
see how much he is getting in the usual twenty minutes 
of nursing. If he is getting more than is required for 

103 



104 DISEASES OF THE OEGANS OF DIGESTION 

his age and size he should be given the breast only for 
ten or fifteen minutes or for the length of time required 
for him to take the proper number of ounces (see page 
13). 

Vomiting which occurs some time after feeding usually 
indicates indigestion. The food comes up in curds and 
may have some greenish fluid, which is bile, mixed with 
it. There may be fever, pain, or restlessness with gas in 
ihe stomach and more or less prostration with this kind 
of vomiting. Older children who have this sort of vomit- 
ing often complain of nausea first and a ^"^stomach ache;'^ 
they may wish to vomit but cannot do so for some time 
after the first discomfort is noticed. When they do suc- 
ceed in emptying the stomach of the undigested food, they 
are greatly relieved. The tongue is usually coated and 
the appetite lost for several days after such an attack. 
Many times intestinal indigestion is present also. 

Treatment, — In cases of this kind the first thing to do 
is to empty the stomach completely. If a doctor is called 
lie will probably wash the stomach, especially in young in- 
fants. This is a simple process and greatly relieves the 
child. If a doctor is not within reach, the mother must 
stop all food at once and give the baby lukewarm water 
in his bottle until he vomits profusely and no more un- 
digested food is seen in the material vomited. 

An older child may be given some syrup of ipecac, usu- 
ally in twenty-drop doses every half hour until the vomit- 
ing takes place, then large draughts of lukewarm water 
which will also be vomited and clear the stomach com- 
pletely. After a little rest a dose of castor oil should be 
given so that any undigested food that may remain will 



DISEASES OF STOMACH AND INTESTINES 105 

pass ofif through the bowels. An enema of warm water 
and soap given high up with a soft rubber catheter is 
often helpful by quickly emptying the bowels and reliev- 
ing the pressure of gas. 

In the case of a young baby only boiled water given as 
hot as it can be taken should be given for three or four 
hours after the vomiting has stopped, then barley water 
or albumin water, and a little later whey may be tried 
in amounts of one ounce at first, gradually increasing the 
amount as the child improves. A nursing baby may be 
given the water and barley or albumin water for the 
first two or three feedings, then given one ounce of boiled 
water or barley water just before each nursing and allowed 
to have the breast for five minutes, gradually working 
back to the usual length of time and then stopping the 
water. When a bottle-fed infant is again put on milk, the 
formula must be a very weak one and often it will be 
wise to peptonize the milk for a few days. Skimmed 
milk or casein milk may be tried. Little by little the 
proportion of milk should be increased until the usual 
formula is reached. 

An older child should be given clear broths of mutton 
or chicken, from which every particle of fat has been re- 
moved. Sometimes these broths are taken better if given 
in the form of cold jelly. Carbonated water, like Vichy, 
is also good and a little later a small piece of zwieback 
may be tried. When milk is given it should be diluted 
considerably and a little lime water added for a few days. 
Four or five days at least should elapse before the child 
is allowed to go back to his usual diet. In these eases the 
mistake should be avoided of dosing the child with medi- 



106 DISEASES OF THE OEGANS OF DIGESTION 

cine which will often make matters worse and prolong 
the attack. 

For pain^, or where the vomiting cannot be checked eas- 
ily^ a small mustard paste made of one teaspoonful of 
mustard and six of flonr mixed into a paste until it is 
smooth with a little cold water^ may be spread between 
two layers of thin muslin and placed directly over the 
child^s stomach for five or ten minutes until the skin is 
red. Hot flannels or a hot water bag placed over the 
stomach will also give relief at times. A child may vomit 
from habit^ regurgitating his food after each bottle; 
gavage feeding helps these cases. 

So many of the contagious diseases are ushered in by 
an attack of vomiting that the mother should always be 
on the lookout for an eruption after a vomiting attack. 

Chronic Gastritis 
Infants 

This is one of the most trying diseases both for the 
mother and physician to deal with. Everlasting patience 
and the most minute attention to detail is necessary; un- 
less the mother will follow instructions given to the let- 
ter, very little improvement will be seen in these cases. 
Chronic gastritis is sometimes spoken of as gastric ca- 
tarrh, catarrh of the stomach, or simply as chronic vomit- 
ing. Pyloric stenosis must be thought of also where a 
baby has chronic vomiting. 

There is an inflammation of the lining membrane of 
the stomach and there is an abundant quantity of mucus. 



DISEASES OF STOMACH AND INTESTINES 107 

In many cases the same trouble exists in the intestines 
also^ but this is not necessarily so. 

Causes, — The disease is much more frequently seen in 
infants than in older children, but when the latter are 
badly fed or have had a severe illness and are much run 
down it sometimes develops in them also. Bottle-fed in- 
fants are more apt to suffer from this trouble than are 
breast-fed ones but even in babies nursed by their own 
mothers chronic gastric catarrh may develop. Babies 
either breast-fed or bottle-fed who are allowed to have a 
meal every time they cry are frequently subject to this dis- 
ease. The stomach is never allowed to be empty and has 
no rest; one meal is put into it before it has had time 
to digest the preceding one, consequently the food sours, 
then ferments and putrefies, and inflammation and ca- 
tarrh are begun. 

It is also caused by the proportions of fat, sugar, and 
protein in the milk, either breast or cow's milk being 
unsuitable for the particular baby, or it may be caused 
by many of the proprietary foods. These poor infants 
are often the victims of much experimenting: one patent 
food after another will be tried until both the doctor and 
the mother have run through the entire list of foods they 
have ever heard of. 

The early use of tea, coffee, or beer will many times 
cause chronic gastritis. 

Symptoms, — The symptoms are vomiting, at first not 
frequently or in large amoimts, of undigested food that is 
sour, and later acid mucus. x\s time goes on the vomit- 
ing will increase in frequency and amount, the baby vomit- 
ing nearly all the time between meals; the abdomen will 



108 DISEASES OF THE OEGANS OF DIGESTION 

become distended with gas; the child steadily lose in 
weight; the fontanel be depressed; the hands and feet 
cold; the face pale and pinched; the stools very consti- 
pated, or if the intestines share in the trouble, undigested 
food and mucus will be passed. The child becomes a 
typical ^^marasmus baby;^^ he sleeps badly and is fretful 
and restless when awake. 

Treatment, — The treatment is best begun with stomach 
washing, using hot water and bicarbonate of soda, as 
described in the treatment of acute gastritis. It is often 
helpful to do this every day for a while, then every second 
and third day as the child grows better. 

It is of the greatest importance that these cases should 
be kept warm; by this I do not mean hot, but just warm 
enough to be comfortable. Hot water bags should be kept 
in the crib and the baby should wear woolen underwear 
and long woolen stockings pinned to the diaper. Massage 
given once a day with a little warm olive oil or cocoa but- 
ter will often help the circulation. I have not found cod- 
liver oil of any more benefit than the above, and its odor 
is so disagreeable. 

Sun baths are often good for these babies; the eyes 
must be carefully protected from the glare. It is impor- 
tant to keep the clothing about' the neck and chest dry, 
as the baby in his weak condition is subject to colds, 
bronchitis, and pneumonia. A piece of waterproof ma- 
terial may be bound with tape and kept under a soft bib 
or towel which is about the child^s neck and can be often 
changed. 

On pleasant days these children should spend much 
of the time out of doors. The baby should have a hot 



DISEASES OF STOMACH AND INTESTINES 109 

water bag in his carriage and not be rolled about much 
but taken to some quiet spot and kept still. When in the 
house he is better off on his back or side in his crib than 
in his mother^s arms. Two or three times a day he may 
be held up over the shoulder for a few minutes at a time so 
that his lungs may expand in all parts^ but never just 
after a meal. The more quiet he is kept after feeding the 
better. Tight clothing should also be avoided. 

Food, — The food must receive the most careful atten- 
tion. If the baby is breast-fed the mother should at once 
have a sample of her breast milk analyzed to see if the fat 
or protein is at fault.* If too high a percentage of fat 
(over five per cent.) is found she should stop taking butter, 
cream, and in some cases meat; also she must give the 
baby some hot, boiled water or barley water just before 
each meal. If the protein is too strong and the fat too 
weak more cream should be taken, also butter, meat, and 
out-of-door exercise. Boiled water may be given in this 
case also. An attempt at least should be made to regu- 
late the mother's milk before it is decided to give up 
nursing. 

If all this proves useless then a good wetnurse should 
be tried if possible. It may be necessary to try several 
before one is found whose milk the baby can digest. If 
a wetnurse is out of the question cow's milk should be 
given, using a weak formula of the plain milk mixtures 
{see page 20), and if it will not stay down peptonized 
milk or skimmed milk should be given. Next in order 
to be tried is casein milk ; then whey. This may be di- 

* Normal average breast milk tests: Fat, 3.50 per cent.; 
protein, 1.25 per cent.; sugar, 7 per cent. 



110 DISEASES OF THE OEGANS OF DIGESTION 

luted with rice or barley water or granum. As a start 
one part whey to four of water or gruel should be given 
and the amount gradually increased. Feedings should not 
occur oftener than every three hourS;, and four is prefer- 
able if any food is vomited between meals. Two ounces 
at a time should be given at first. A spoon or medicine 
dropper may be used in place of the nursing-bottle if the 
nipple seems to make the child gag. 

Beef juice or diluted mutton broth may next be tried 
in small quantities. Condensed milk diluted with twenty 
parts of water at first is the next alternative of possible 
foods. I have found that a German preparation called 
^^Eamogen^^ is often retained in obstinate cases of gastritis. 
It must be admitted that the proprietary foods succeed 
in a few cases where all forms of milk have failed^ but 
they should be tried only as a last resort; and then as 
soon as the vomiting has stopped cow's milk should be 
added to them little by little until the baby can take 
a regular modified milk formula. One should never begin 
to experiment with these foods at the onset of the disease. 

In a bottle-fed baby much the same method must be 
pursued. Very often these bottle-fed babies will begin 
to do well at once if a suitable wetnurse can be found. 
Sometimes they refuse to take the breast because they 
have always been used to a rubber nipple. In such cases 
a nipple shield should be used and the infant will then 
draw on it v/ell. It is often a good plan to give whatever 
is being used for food at intervals of four or even six 
hours and at intervals intervening to give a half teaspoon- 
ful of peptonoids or panopepton in half an ounce of water, 
either very hot or very cold. Very small quantities of a 



DISEASES OF STOMACH AND ^TESTIXES 111 

strong formula of modified or peptonized milk will some- 
times be retained better than larger amounts of a weak 
formula. This plan should be tried before deciding to 
give up milk^ also feeding by gavage two or three times 
daily^ as food given in this way may be retained. Casein or 
protein milk already mentioned often succeeds in these 
cases (see page 28). 

If the child is constipated it will be better to give a 
suppository or even an injection than to try to give laxa- 
tives by the mouthy which would in all probability be 
vomited. If a free movement cannot be obtained in this 
way the milk of magnesia or very minute doses of calomel 
(one-twentieth or one-tenth of a grain every hour until 
half a grain or one grain has been taken) are very often 
the best remedies. When so little food is being retained 
it is only natural that there should be little passed through 
the intestines. 

Older Children 

Treatment. — Older children with chronic gastritis are 
easier to treaty but they should be made to obey the rules 
laid down by the mother or doctor. Plenty of fresh air 
and sun^ with moderate exercise, a daily tepid bath fol- 
lowed by a dash of cold water down the spine and on the 
chest, and a brisk rub to start up the circulation. 

A teaspoonful of the rhubarb and soda mixture three 
times a day, which should be given after meals, will some- 
times be beneficial. If a laxative is needed citrate of mag- 
nesia is about the best and most pleasant to take. The 
abdomen must be covered by flannel even in these older 
children and the hands and feet kept warm. 



112 DISEASES OF THE OEGANS OF DIGESTION 

Food, — If milk is tolerated at all, it should be diluted 
with a little lime water or Vichy at first ; buttermilk should 
be tried. Dry toast or zwieback, clear broths, soft boiled 
or coddled eggs, or raw beef sandwiches are the articles 
most likely to be reta,ined. 

Three regular meals a day must be given, and the 
mother should not yield to a plea for lunches between 
meals. No sweets should be allowed or any rich foods, as 
pies, cakes, etc. 

Recurrent or Cyclic Vomiting — Acidosis 

Occurrence, — This disease is not infrequently met. It 
may occur in infants but is most common in children 
between two and four years of age. 

Duration, — The attacks may last over a period of years, 
recurring at irregular intervals. 

Causes, — tChildren of neurotic parents often suffer from 
this disease; usually an attack cannot be traced to any one 
cause. Often a too starchy diet, especially where potatoes 
and too much oatmeal have been given, may be responsible 
for an attack. Again an attack may follow one of tonsil- 
litis or bronchitis. I recently watched a little patient have 
a very severe attack after grippe. In a country town not 
long ago, there was quite an epidemic of this so-called 
acidosis^ some of the cases being so ill that they did not 
recover. As a rule, however, the attack lasts but two or 
three days. 

Symptoms, — Often there will be a day of languor with 
loss of appetite and dark rings under the eyes; some- 
times the stools are white or there is some constipation 



DISEASES OF STOMACH AND INTESTINES 113 

and coated tongue. The temperature may range from 
101° to 104° F. or higher, but it drops often to 100° F. 
The vomiting then begins rather suddenly. It occurs when 
no food is taken and is violent in character; if water or 
any food is tried the vomiting becomes worse; usually 
nothing at all can be retained — the child cries for water 
but cannot retain even this. Often if the attack is a 
severe one the child will pass into semi-consciousness and 
appear much exhausted. The urine will be scanty and 
highly colored and if it is analyzed there will generally be 
found a substance called indican and also acetone. The 
material vomited may first consist of food and later watery 
mucus and even some blood. As the child reaches the 
maturing period very often the attacks will entirely cease. 

Treatment and Diet, — If from experience the mother 
can tell before an attack actually comes on, then she may 
possibly prevent it by giving calomel with the approval 
of her physician. If the vomiting has once started^ how- 
ever, nothing seems to have any effect in stopping it. 
Some physicians have tried large doses of bicarbonate 
of soda given very frequently, but as yet this has not been 
tried frequently enough to be sure of its success. 

The child must be kept perfectly still in bed, and water 
— six to eight ounces — ^given with a long catheter by the 
rectum. This will help the kidney action and relieve, to 
some extent, the great thirst. It may be repeated four or 
five times daily. 

After the vomiting has ceased small quantities of fat- 
free broth, kumyss, zoolak, or matzoon may be tried, at 
first only an ounce every hour or two, and later the quan- 
tities gradually increased as the child grows stronger. 



114 DISEASES OF THE OEGANS OF DIGESTION 

Starchy foods should be greatly limited for some time 
at least and never given to any excess at any time in a 
child with this tendency. The best diet for these children 
consists of green vegetables^ meat^, some milk^ stale bread, 
the latter usually of the whole wheat variety. iSTo candy 
or cake should be allowed^ and very little cereals and no 
potatoes. Eggs agree with some of these children^ but in 
other cases they do not act well. Usually a little white 
fish may be taken and some fruit. 

If the mother can have the urine tested about every 
months in this way she may be able to tell when an attack 
is coming on^ and by promptly giving calomel and cutting 
down the diet^ or by giving bicarbonate of soda in doses 
of fifteen to thirty grains in water three times daily, she 
may possibly ward off an attack. 

Bowel Movements or Stools 

To know when the movements of the bowels are abnor- 
mal the mother must first know what is normal in the 
case of babies and young children. During the first few 
days of life a substance, called meconium^ is passed from 
the intestines. This is a dark-green^ sticky mass and has 
been formed in the baby's bowels before birth; it is per- 
fectly normal. 

After the baby has begun to take milk, however, the 
character of the stools should change to an orange yel- 
low if the baby is breast-fed^ or a little lighter yellow if 
he is bottle-fed. Normal stools should be smooth and yel- 
low, about the consistency of thick cream or thin porridge 
and contain no curds or lumps. In the case of a breast- 



DISEASES OF STOMACH AND INTESTINES 115 

fed baby^ fine white specks or curds in the stools need 
cause no alarm if the baby is otherwise well. In a bottle- 
fed baby if the curds are seen it is usually best to make 
some slight change in the food. 

During the first year of life there should be very little 
odor to a baby's stools ; after this they generally have some 
at least. They should number from one to three or four 
in twenty-four hours during the first six months; then 
over two stools daily are not often found in a perfectly 
normal child, but as many as four or five small ones may 
be passed without alarm if they are normal in character 
and the baby is otherwise perfectly well. As long as a 
baby has one free stool daily he cannot be said to be con- 
stipated. When the baby begins to take solid food at the 
age of one year the movements usually are formed and 
soon become darker as the different articles are added to 
the diet. If a stool becomes slightly green after standing 
a little while it is still a normal stool. 

Abnormal Stools 

Curds in the Stools. — Little white lumps or specks vary- 
ing from the size of a pinhead to a small nut are quite 
often seen in cases where there is more or less indigestion. 
If these curds are soft, large, and white, they are com- 
posed almost entirely of fat and show that there is more 
cream or fat in the milk than can be digested by that 
particular infant. In such a case, if the baby is fed at 
the breast, the mother should proceed as in the case of 
gastritis caused by excess of fat, as already described on 
page 109. If the baby is a bottle-fed child then a formula 



116 DISEASES OF THE ORGANS OF DIGESTION 

containing less cream or fat should be used^ or if the case 
is a very bad one it may be necessary to give skimmed 
milk for a time. 

Curds seen in the stools may be hard^ tough, and yel- 
lowish; sometimes these are brownish but on being cut 
open look white. These are the protein curds and if seen 
frequently in a breast-fed baby the mother should do as 
advised on page 109. If seen in the stools of a bottle-fed 
child^ a little more cream and a little less of the lower 
part of the bottled milk should be tried, or if boiled water 
is being used as the diluent of the food a cereal gruel, like 
barley or rice water, should be given. A dose of castor oil 
should precede this in either case. There will often be 
some mucus with these curdy stools. 

Loose, Green, or Yellowish-green Stools Having a Sour 
Odor. — These stools have sometimes been likened to 
^^scrambled eggs.^^ They generally denote too much sugar 
in the food and sometimes too much fat as well. The 
sugar should be reduced in quantity or in some cases malt 
sugar may be used in place of milk or cane sugar. If this 
does not make the stools normal then proceed as for 
fat curdy stools. Mucus may also appear with these 
stools. 

Large, Dry Clay-colored or Whitish Stools. — These stools 
usually denote a sluggish liver often caused by excess of 
fat in the food. They usually have a foul odor. The fat 
should be cut down or skimmed milk used. A butter- 
milk mixture, or casein milk, may be tried {see page 
28). 

Hard, Dry, Constipated Stools, — See treatment of con- 
stipation on page 131. 



DISEASES OF STOMACH AND INTESTINES 117 

Thin, Watery, Yellow or Green Stools With or Without 
Mucus and Blood, — See Treatment of Diarrhea, pages 120- 
124. 

Stools of Other Colors. — Certain medicines show in the 
stools at times and change their appearance very much. 
Bismuth and iron usually make the stools black, while calo- 
mel causes green stools, and much malted food or sugar, 
as Mellin^s Food, for example, will cause the stools to 
appear brown. 

Stools sometimes leave a pink stain on the diapers. This 
is of no special significance and is due simply to a change 
in the bile pigments. Stools in a young baby that are very 
black after the first few days of life should at once be 
examined for blood. These are called tar stools, and are 
sometimes seen in a baby who has the bleeding disease, or 
what is known as melena. Dark spots of blood may also 
be seen in cases of dysentery and other intestinal dis- 
eases. 

ACUTE INFECTIONS OF THE STOMACH AND 
INTESTINES 

Simple or Summer Diarrhea 

Simple or summer diarrhea, often called ^^summer com- 
plaint,^^ is one of the most frequent diseases to which 
babies are subject. The stomach is usually involved as 
well as the intestines. The mortality among infants un- 
der one year of age is great, but within the last few years 
it has been considerably reduced. 

Causes. — Bad surroundings, summer heat, living where 

dirt and close, hot air prevail, irregular or incorrect feed- 
9 



118 DISEASES OF THE OEGAISrS OF DIGESTION 

ing, infected milk are among the causes of summer 
diarrhea. 

Breast-fed babies may have the disease also but are much 
less liable to it than are bottle-fed infants. Marasmus 
babies and those whose vitality are lowered from any 
special cause are frequent victims. 

Symptoms. — The first symptoms are generally increase 
in the number of stools^ which are thin and yellow, then 
green or brown in color, and have a sour or foul odor; 
very often there is also some vomiting. The abdomen is 
distended from gas and usually there is a little fever — 
100° to 101° F. There is marked loss in weight. The 
fontanel becomes depressed and the child restless and 
sleeps badly. In children who have before seemed per- 
fectly well the onset is often very sudden and severe. 

The attack begins with hard vomiting, the fever is 
high, often 105° F. In a few hours the diarrhea begins, 
the stools being yellow with undigested food, then green 
and often frothy with a bad odor. The stools are very 
frequent, twenty or more being passed in twenty-four 
hours; consequently the skin about the anus and aU over 
the buttocks may become very much irritated and the 
pain great whenever the baby has a movement or passes 
urine. The sunken eyes and pinched, drawn look in the 
little face is sad to see. If the treatment has been prompt 
these cases usually recover but if neglected or if the sub- 
ject is a weak one the baby goes from bad to worse and 
finally dies, perhaps having convulsions before the end. 

Prevention. — As an ounce of prevention is always worth 
many pounds of cure, the mother of a young baby should 
spare no pains in caring for him during the heated term. 



INFECTIONS OF STOMACH AND INTESTINES 119 

If it is at all possible;, the baby should be taken out of 
the hot city during the summer; if not, he should be 
kept in the parks or recreation piers or taken for day 
trips into the country or seashore. Care must be taken 
that the abdomen is covered with a woolen band ; straight 
flannel bands are best for babies under two months old. 
Mixed silk and wool knitted bands with shoulder straps 
should be worn up to at least the third year. This and 
a diaper with a thin cotton slip and light silk and woolen 
stockings pinned to the napkin constitute enough clothing 
for an excessively hot day. On cooler days a gauze shirt 
and thin flannel petticoat may be added. 

Draughts should be guarded against; also sudden 
changes in the weather, all sudden chilling of the body 
surface. Frequent cool sponge baths with a little alcohol 
or bicarbonate of soda in the tepid water should be given. 
Boiled water which has been cooled should be given be- 
tween each meal. The greatest care in cleaning bottles 
and nipples and in handling everything that belongs to 
baby should be exerted. 

If possible a breast-fed baby should not be weaned in 
the middle of summer; it should preferably be done be- 
fore the hot weather. One should make an effort to ob- 
tain the very best milk for the baby, and even then it is 
sometimes safer to pasteurize it while the excessive heat 
lasts unless certified milk can be had. The strength of the 
formulas should not be very rapidly increased in summer ; 
one should go slowly and be satisfied with a smaller gain 
in weight. A good plan on very hot days is to pour out 
one or even two ounces of the food from each bottle of milk 
and substitute the same amount of boiled water, or give 



120 DISEASES OF THE ORGANS OF DIGESTION 

one meal of gruel or mutton broth free from fat and 
gruel equal parts in place of one of the milk feedings. A 
breast-fed baby may be given the barley water or boiled 
water just before nursing. 

At the very first sign of indigestion a dose of castor oil 
should be given, all milk stopped until the baby is again 
perfectly normal. 

Treatment, — When an attack of "summer complaint^^ 
has actually set in, the child should be kept quietly in bed 
in a cool room when in the house, but every minute pos- 
sible he should spend out of doors in some shady spot 
where the breezes can reach him. His feet and abdomen 
must be well protected so he will not become chilled. He 
should not be held in hot arms nor should one walk the 
floor with him; this sort of thing is both heating and 
exciting. If the baby is in the city he should be taken 
into the country or to the seashore if possible; a change 
of air will many times break up an attack. After each 
movement the buttocks should be washed off with pure 
olive oil, then powdered with a pure toilet powder. The 
one we used in The Babies^ Hospital of New York City 
was as follows: 

One ounce of starch. 

One ounce of talcum. 

One-fourth ounce of boric acid powder. 

All should be well mixed together. 

The moment a diaper is wet or soiled it must be re- 
moved and placed in the pail of disinfectant and boiled 
before being used again. 

As to the food, all milk should be stopped at once, either 



INFECTIONS OF STOMACH AND INTESTINES 121 

breast milk or bottle milk and nothing but cool boiled 
water or barley water should be given in small amounts, 
one-half or one ounce every two hours at first, or albumen 
water may be given in the same way if the stomach is 
very irritable. This will often be retained better than 
anything else. When the temperature is reduced and the 
frequency of the stools and vomiting a little less (usually 
after twenty-four or forty-eight hours) a little mutton 
broth and barley or rice water may be tried; next whey 
may be added to the barley water or whey and imperial 
granum water; next one teaspoonful of whole milk (not 
cream) may be tried with either four ounces of granum or 
barley water. Following this, little by little, more milk 
should be added until the original formula is reached. 
Casein or protein milk may be used here sometimes with 
advantage. 

In the case of breast-fed babies the breast may be re- 
sumed at the end of twenty-four hours as a rule but given 
after the barley or boiled water, and only for three or five 
minutes at first, gradually increasing the length of the 
nursing as the child improves. If at any time, however, 
the temperature goes up or the diarrhea increases the milk 
must again be stopped. One should ^^make haste slowly'^ 
in these cases, not forgetting to give boiled water in small 
doses, but often; the baby is losing so much water from 
his tissues by the frequent thin movements that this must 
be made up in some way. 

Older children should have very much the same treat- 
ment; no milk whatever at first, but thicker gruels and 
clear broths. When milk is again begun it may be scalded 
and added gradually to the gruels. 



122 DISEASES OF THE OEGANS OF DIGESTION 

As usual in the case of babies, the medicine given is of 
secondary importance to the correct management of the 
food, but something to clear the alimentary tract must be 
given here. If the stomach will tolerate it a dose of castor 
oil is the best remedy. 

Schedule fob Dose of Castor Oil 
Age Amount 

Under 1 year 1 teaspoonf ul 

1 year — 2 years 2 teaspoonfuls 

after 2nd year 1 tablespoonf ul 

If the stomach is very irritable and the temperature 
high^ calomel may be needed in place of the castor oil. 

Schedule for Dose of Calomel 
Age Amount Time 

imder 2 years Vio grain every hour, for 10 doses 

2 years or older Vs grain every hour, for 6 or 8 doses 

If the stools are not frequent after the calomel, the milk 
or the citrate of magnesia may be given to carry off the 
medicine but usually with babies and young children this 
is not required. 

Never under any circumstances should opium, as pare- 
goric or in any other form, be given until the bowels have 
been thoroughly cleared out; these drugs lock the poison 
in the system and prevent nature from ridding the intes- 
tines of it. Paregoric may be needed afterwards if the 
physician thinks it advisable^ but never should it be al- 
lowed early in the attack. One administration of castor 
oil or calomel may not be enough ; if the temperature be- 
comes higher and undigested food continues to appear 
in the stools the dose should be repeated. 



INFECTIONS OF STOMACH AND INTESTINES 123 

The day following the taking of castor oil or calomel, 
spiced syrup of rhubarb^ in small repeated doses, is often 
very beneficial. The usual doses are given here : 

Schedule for Spiced Syrup of Rhubarb 
Age Amoimt Time 

under 6 months 5 drops every 3 hours, for 6 or 8 doses 

6 months — 1 year .... 10 drops every 3 hours, for 6 or 8 doses 

1 — 2 years 20 drops every 3 hours, for 6 or 8 doses 

Should the baby vomit this medicine it must be discon- 
tinued^ but if given midway between meals when the 
stomach is comparatively empty it will usually be re- 
tained. Preparations of bismuth in different forms and 
various chalk mixtures are prescribed by many physicians 
and are sometimes needed if the stomach can bear them. 
The bismuth mixtures will turn the stools black. Opium 
as paregoric, Dover^s powder, etc., should be given only 
on written prescriptions from the attending physician. 
These drugs check the excessive action of the bowels and 
relieve pain but are dangerous unless given by a skilled 
person who can watch the results daily. Irrigating the 
bowels with salt solution is often helpful. For methods of 
doing this see pages 66-68. 

When there is much prostration it may be necessary to 
give stimulants of some kind. Liquid peptonoid con- 
tains alcohol and is a food as well as a stimulant; there- 
fore it is often valuable in these cases. Brandy added to 
the albumen water in proportions of one teaspoonful to 
eight ounces is also good, or if the child seems very vreak 
it may be given in cold water, one part of the brandy to 
six or eight of the water. It is a good plan to put one- 
half ounce of brandy and four ounces of cold water into 



124 DISEASES OF THE OEGANS OF DIGESTION 

a corked bottle^ place near the ice and give it to the baby 
every hour or two in teaspoonful doses. This amount 
will last for twenty-four hours. It is best not to add 
sugar^ but if the child refuses it a few grains may be 
added. 

To control the fever^ alcohol sponge baths^ not medicine, 
should be given^ and if the fever is high^ the baby restless 
with signs of convulsions or extreme nervousness^ an ice 
bag placed at the head will often quiet the child. 

Cholera Infantum 

This is a disease that strikes terror to every mother's 
hearty and it i^, in fact, one of the most serious intestinal 
diseases of infancy. It is not as common as some believe ; 
many cases of simple diarrhea are wrongly called cholera 
infantum. The true disease resembles real cholera and is 
met with in young babies — ^never over three years of age 
and generally under one year. 

Causes, — It occurs in summer and may attack a healthy 
child or one who is already weakened by some other form 
of diarrhea. It should be looked upon as an acute poison- 
ing of the system and is usually caused by impure milk. 

Symptoms. — The beginning of the disease is very sud-» 
den and violent in the extreme. The vomiting is severe at 
firsts consisting of food, then thin watery fluid with some 
mucus. It is often almost incessant. The diarrhea soon 
begins, the stools being composed of thin, colorless water 
called ^^rice water stools^^ and having a musty odor. These 
may be so frequent as to be almost constant, it being 
impossible to keep count of them. The temperature is 



INFECTIONS OF STOMACH AND INTESTINES 125 

usually very high and may even reach 107^ or 108° F. 
The face is drawn and sunken, the fontanel much de- 
pressed, the hands and feet cold, the baby limp from ex- 
haustion or moaning and twitching, or there may be con- 
vulsions. There is extreme thirst, the breathing and pulse 
are shallow and weak, the urine is scanty. If these cases 
are to result fatally the child rarely lives more than two 
or three days at the most. The loss in weight is great; 
a baby may easily lose three pounds in as many days. It 
is not impossible, however, for the little patient to recover, 
and quick, skillful methods should at once be begun. 

Treatment. — All food must be at once stopped and the 
stomach and bowels quickly washed with normal salt so- 
lution at a temperature of 100° or 90° F. : there is no 
time to wait for calomel or castor oil to act. To control 
the extremely high temperature, baths are the best means. 
So that the shock may not be too great, the water should 
at first be 100° F. ; while the baby is in the tub the water 
may be reduced to 90° or even 85° F. This is best done 
by allowing cold water to run into the tub gradually, keep- 
ing close watch of the bath thermometer, and constantly 
rubbing. This may be given every three hours and in the 
interval an icebag should be kept at the child's head. 
When taken out of the bath, if the feet are very cold and 
the child extremely weak, a hot water bag should be placed 
at the feet while the icebag is at the head. Small quan- 
tities of brandy and water or egg water may be tried by 
the mouth, but these are seldom retained and it will be 
necessary for the doctor to give injections of salt solution 
under the skin. As the vomiting diminishes the same 
method in regard to food may be pursued as described in 



126 DISEASES OF THE OEGANS OF DIGESTION 

treating of summer complaint {see pages 120-121). Liquid 
peptonoids, brandy^ and iced champagne are as a rule 
the first fluids tolerated by the stomach. 

For medicine^ hypodermic injections of morphin and 
atropin are by far the best; these must be given by the 
physician or trained nurse. 

The return to the usual food must be made even more 
slowly than in other diarrheal and vomiting cases. 

Chronic Intestinal Indigestion 

Children of all ages may have this affection^ but it is 
most frequently seen from the sixth month to the second 
year. Either breast-fed or bottle-fed babies may have it, 
but bottle-fed infants are by far the more frequent suf- 
ferers. 

Causes. — Older children who are greatly indulged in 
the way of sweets, pastry and rich, unwholesome food are 
frequent sufferers. These children have usually been al- 
lowed to come to the family table from the time they could 
sit up and have been allowed to have ^^just a taste^^ of 
everything they may happen to fancy, tea and coffee not 
excepted, and with many families they are even given 
beer ! 

Symptoms. — The general appearance of a child suffer- 
ing from intestinal indigestion in its chronic form is 
typical. He wiU be stunted in growth as a rule, have an 
old, rather wizened face with sharp features, a thin body 
but very prominent abdomen, and the head may be out of 
all proportion to the rest of the body. The thin little legs 
will hardly seem capable of supporting the child if he 



INFECTIONS OF STOMACH AND INTESTINES 127 

walks. The color of the face is pale^ there being marked 
anemia; the stools are mostly gray or brown if diarrhea 
is present^ but most of the time there is constipation; the 
stools are expelled with an effort and are like pntty; the 
constipation may last for months with an occasional at- 
tack of diarrhea. In infants the stools show the masses 
of undigested food more plainly than in older children, 
either fat;, curds, or proteid being seen. The fat curds 
are softer and often appear in white or yellow masses. 
More or less mucus may also be found. There is loss in 
weight or failure to gain, the child remaining stationary 
for long periods at a time. 

There are many nervous symptoms; the children are 
poor sleepers, and are fretful and whining when awake. 
The circulation being so poor, both infants and older chil- 
dren usually have very cold hands and feet most of the 
time. There may be frequent skin eruptions, peculiar 
flushes, and urticaria or what is known to many as 
^^hives.^^ 

Treatment. — The chief factor in the treatment must, 
of, course, be the food. In breast-fed infants the mother's 
milk must at once be analyzed and if too much fat or too 
much protein is found the mother's diet must be regulated, 
as already described on page 109. The baby may be given 
the boiled water or barley water also. If after a period 
of a week or two no improvement can be seen it will be 
best to stop the breast milk, at least partially, and use 
modified milk, beginning with a weak formula and work- 
ing up. It is a good plan at first to alternate the breast 
and the bottle before giving up the breast feedings en- 
tirely. No attempt should be made to use a milk mixture 



128 DISEASES OF THE OEGANS OF DIGESTION 

heavy in cream; the plain milk mixtures or those taken 
from the upper sixteen ounces of a qnart bottle of milk 
will as a rule succeed better than those which are pre- 
pared by taking the top three or four ounces from each 
of several bottles or those from heavy cream. Protein 
or casein milk is sometimes well borne here. 

In bottle-fed babies these same formulas should be tried 
faithfully, using either boiled water or a dextrinized gruel 
as the diluent. These dextrinized gruels here give the 
necessary aid to the feeble digestion of the intestines, as 
much of the starch in the gruel flours is already digested. 
"Malt Soup^^ and protein milk may be tried. Completely 
peptonized milk may have to be used with these gruels until 
the intestines are stronger and capable of doing a little 
work for themselves. All methods of using cow^s milk 
should be tried before giving it up for one of the patent 
foods. 

The general care and hygiene of the child should be ^s 
already described on pages 108 and 111. 

In the case of older children who have been accustomed 
to "eat everything'^ the task is often difficult in the ex- 
treme and impossible without the hearty cooperation of the 
mother. These children are often so thoroughly spoiled 
by their parents that it is almost impossible to get them 
to eat proper food. They will eat when they are hungry, 
and whatever they fancy, and their foolish mothers allow 
them to do this because they are afraid they will starve ! 
I have seen children fed chiefly on cake and candy because 
they "wouldn^t eat anything else.^^ No wonder their in- 
testines gave out! 

Three regular meals a day must be given and a glass of 



INFECTIONS OF STOMACH AND INTESTINES 129 

milk or buttermilk — no cracker — between meals if the child 
is hungry; otherwise it is best to keep to the three meals 
alone. These must be served by the clock, no irregularity 
being allowed. It is a good plan to begin the day by 
giving these children a glass of water with orange juice 
in it, unless the bowels are very loose, half an hour before 
breakfast. Their breakfast should consist of a glass of 
milk and a soft boiled or coddled egg. 

For dinner a cup of clear broth, one or two tablespoon- 
fuls of rare beef scraped fine, chicken or lamb chop with 
zwieback, or raw oysters may be substituted for the meat 
once or twice a week, the soft parts alone being given. 
For dessert, junket, Irish moss, blanc mange or custard 
without corn starch, and for supper whole wheat toast and 
milk. As the child improves green vegetables may be 
gradually added, but not starchy ones like potato or maca- 
roni, and no cereals until the stools are almost normal, 
as starches must be avoided in these cases. When there 
is marked constipation it will be advisable to add a tea- 
spoonful of Mellin's Food, or a malt sugar to each glass 
of milk. 

For this same purpose calomel given every week, fol- 
lowed by magnesia or Eochelle salts the next morning, will 
be beneficial : one-fifth of a grain given every hour for six 
or eight doses may be given a child of two or three years. 
For the rhubarb and soda mixture — one-half to one tea- 
spoonful three times daily after meals — is helpful here, 
especially when there has been an outbreak of hives. Lac- 
tobacillin tablets, or the Bulgarian bacilli in other forms, 
are sometimes very helpful too; other medicine is best 
left alone. 



130 DISEASES OF THE OEGANS OF DIGESTION 

A substance called indican is nearly always found in the 
urine of children who have intestinal indigestion^ and it is 
helpful to have the urine tested once a month. The child 
grows better as the indican grows less. Occasional high ir- 
rigations of the intestines are sometimes needed. 

With strict attention to detail and wise handlings there 
is hope of complete recovery^ although much time is usually 
needed to effect a cure. 

Chronic Constipation 

Chronic constipation is many times simply a symptom 
of another disease; but again it is so persistent in an 
apparently well child that it may be looked upon as a 
disease by itself. 

Causes. — Constipation may be caused by some malfor- 
mation of the bowelS;, or very often from some muscular 
weakness^, or from lack of secretions of the liver or intes- 
tines, or it may be due to the food. Again, habit has 
much to do with constipation; if children have not been 
trained early to use a chamber or to go to the closet at a 
regular time every day, constipation often results. 

Symptoms. — Although an infant usually has more than 
one movement a day, he cannot be said to be constipated 
if he has one soft, smooth, free stool. A hard, dry stool 
passed with some effort always means constipation, no 
matter how many times a day this may occur. 

Babies who are constipated are frequently much 
troubled with gas, and hence colic results. They may be 
restless, poor sleepers, and have sudden attacks of fever, 
which can be explained only by lack of a free movement; 



INFECTIONS OF STOMACH AND USTTESTINES 131 

this temperature promptly drops when the bowels have 
moved. From the excessive straining there may often 
be prolapse of the rectum with some blood, or else hemor- 
rhoids may develop. The tongue is generally coated and 
the breath foul, especially in the morning; there may be 
mucus with the hard, dry, lumpy stools. The child is 
usually pale, and if he is old enough he will complain 
of headache and be listless at times. This is a very stub- 
born thing to treat, especially where there is a tendency 
to the disorder in the family, but some effort must be 
made at all times to correct it. 

Treatment. — In breast-fed babies the trouble is often 
the most difficult to overcome. It may depend to a great 
extent on the mother, if she is constipated herself. If 
such is the case she must drink well-salted cornmeal gruel 
made thin, a whole bowlful between meals and at bedtime, 
and eat with each meal bran gems. She must take fruits 
and drink plenty of water, and take exercise out of doors. 
She must have at least one free movement of her own 
bowels every day. If the breast milk shows on analysis 
that the fat or protein is too low or too high, the usual 
course to correct these troubles must be followed {see 
page 109). One breast-fed baby who came to me for treat- 
ment was made excessively constipated by the mother's 
tea drinking. She drank quantities of tea every day, as 
she had been told that it would increase the milk supply. 
On stopping the tea drinking the baby was soon all right. 

Some nursing babies are constipated because they do 
not get enough in quantity ; they have not enough residue 
in the intestines to pass. The baby should be weighed 
before and again just after each nursing, to see if he gets 



132 DISEASES OF THE ORGANS OF DIGESTION 

enough food^ and if he does not it will be a good plan to 
alternate the breast with the bottle^ thus giving the breasts 
more time to fill. One ounce of oatmeal gruel may be 
given a nursing baby before each nursings sometimes with 
one or two teaspoonfuls of cream in it. Orange juice^ one 
teaspoonf ul to one tablespoonf ul, given in an equal amount 
of water between meals several times daily may be tried 
if the baby is over three months old. Olive oil given in 
teaspoonful doses the first thing in the morning and also 
between meals, if once a day is not sufficient, will sometimes 
help. If the fault lies with weakness of the rectal muscles, 
then try suppositories. The gluten Health Food or a soap 
stick may be used, and if these are not sufficient, a bulb 
syringe with one ounce of olive oil and one teaspoonful of 
glycerin may be used, otherwise a little soapsuds. It is 
not well to use enemata, however, if it can possibly be 
avoided, and medicine should be the last resort. By the 
time the baby is six weeks old he should be able to use 
a small chamber placed in the mother's lap. The position 
alone is often enough to overcome constipation. A piece 
of oiled paper or a small soap stick may be inserted in 
the rectum at first to start the child and teach him why 
he is put on the chamber. If this is done directly after a 
meal at exactly the same time every morning, the results 
will often be surprising. 

In bottle-fed babies the trouble may be due to too 
weak a formula, the fats and proteins both being too low. 
The strength of the food should gradually be increased 
as long as there are no curds seen in the stools and the 
child does not vomit, but this should be stopped at once 
if any signs of indigestion are seen. Lime water in the 



INFECTIONS OF STOMACH AND INTESTINES 133 

food is many times the cause of constipation; this may be 
omitted from the formula and bicarbonate of soda or milk 
of magnesia tried in its place. Perhaps the diluent used 
may be the cause of the trouble. Barley and wheat gruels 
are often constipating; if these are employed oatmeal may 
be tried in their stead. Malt sugar may be substituted for 
milk sugar in the formula or one of the malted foodS;, as 
Mellin^S;, in its place. One or two tablespoonfuls to the 
entire formula may be used. Condensed milk is very apt 
to be constipating on account of its lack of fat. The 
orange juice water^, etc.^ may be given here just as in the 
case of breast-fed babies, also the early training to the use 
of the chamber should be tried. Beef juice is a laxative to 
some children: this may be tried either alone or diluted 
with water, gi'^iiig at first one teaspoonful three times 
daily between meals and working up to a tablespoonful. 

Older children who are constipated should eat laxa- 
tive foods, such as bran gems, cornmeal and graham mush, 
fruit, prune jelly, and drink buttermilk in place of sweet 
milk. They must be made to take a regular time for the 
toilet every morning. Out-of-door exercise and abdominal 
massage will also help these older children. As a last 
resort a high enema of olive oil may be tried until the 
regular habit of moving the bowels is established. 

In the case of older children, special gymnastic exercises 
may be tried also. 

Colic 

While colic cannot strictly be called a disease it is so 
distressing a symptom of indigestion that it demands a 
few words by itself. 
10 



134 DISEASES OF THE 0EGA:N'S OF DIGESTION 

Causes, — Anything that produces a collection of gas in 
the stomach or bowels may cause colic. It may occur with 
other diseases of the stomach and intestines^ but in young 
infants it is due to indigestion, as a rule. In breast-fed 
babies constipation in the mother, extreme nervousness or 
emotional disturbances very often cause colic. The first 
six months of life, especially the first three months, is the 
period when colic is most often seen. Decomposed food, 
which putrefies and causes flatulency and gas in the stom- 
ach or intestines, is the chief cause, however. Either the 
fats or the proteins in the milk may be the cause of colic, 
but much more frequently the proteins are in excess and 
cannot be digested. The sugar which has been added to 
the formula of cow's milk many times causes severe colic. 
Constipation is a very frequent cause. Some of the cereals, 
and especially patent foods, often cause bad attacks of colic. 
Sudden chilling of hands and feet, or exposure to cold, 
may be the cause also; in these instances there is no gas 
seen in stomach or intestine — it is more a muscular spasm 
of these organs. 

Symptoms, — Few mothers with young babies escape see- 
ing at least one attack of colic, and are familiar with the 
symptoms. The attack may come on shortly after the 
food is taken, or it may occur at intervals between meals. 
Very often it takes place after the evening meals, especially 
in a breast-fed baby whose mother is more or less tired at 
this time. The baby with colic screams lustily and in 
paroxysms; his face is first red, but may become pale or 
even blue around the mouth if the attacks last long and are 
severe. The hands and feet are cold, the legs drawn up; 
the abdomen, as a rule, very hard and distended, and the 



INFECTIONS OF STOMACH AND INTESTINES 135 

baby works his hands in agony. As soon as the gas is 
passed either through the month or the rectum there is 
some relief^ and the infant usually falls asleep. 

Treatment. — For the actual attack of colic, either in 
breast-fed or bottle-fed babies, warmth must be applied to 
the abdomen and hands and feet. Hot flannels may be 
placed on the abdomen or the baby may lie on a hot water 
bag across the mother^s lap. Holding the child up over 
the shoulder and patting its back will often bring up the 
gas. Warm mittens and wool stockings should be put on 
the hands and feet, and a hot water bag placed at the feet. 
No food must be given during or directly after an attack, 
as this only increases the pain. 

If the gas is mostly in the stomach an ounce of hot 
water may help to bring it up. If this does not do, one- 
half a soda mint tablet should be added to the hot water, 
or ten drops of peppermint or a pinch of bicarbonate of 
soda. If the gas is in the intestines an injection of four 
or five ounces of w^arm water will often help expel the gas. 
If the injection does not help, a long rubber catheter 
should be worked up as high as it will easily go, and the 
bowels irrigated with lukewarm water, as described on 
pages 66-68. Paregoric and such remedies must not be 
given unless ordered by a doctor. Beware of patent "colic 
cures.^^ 

Besides treating the attack itself the cause of the colic 
must be sought and treated. In a breast-fed baby, if the 
mother is nervous and excitable, she must use every effort 
to control herself. When the attack occurs regularly after 
the evening meal, and is caused by fatigue in the mother, 
it would be a good plan to give one bottle meal of a weak 



136 DISEASES OE THE OEGANS OE DIGESTION 

milk formula^, or even barley water, in place of the breast 
feeding. The mother should have her milk tested, if pos- 
sible, and if the fats or proteins are found at fault, should 
proceed as already advised on page 109. Hot water, one 
ounce, with a pinch of bicarbonate of soda in it given 
about five or ten minutes before a meal, either in breast or 
bottle-fed babies, may prevent an attack of colic. If the 
mother is constipated, or is eating food that causes in- 
digestion in herself, she must be treated by a doctor before 
she can expect her baby to recover. In the case of bot- 
tle-fed babies, the formula should be weakened and the 
intervals between meals made longer, and absolute regu- 
larity observed in feeding the baby ; if this does not help, 
the sugar should be left out or greatly lessened in the 
formula. 

Milk sugar or malt sugar usually causes colic less often 
than cane sugar. If one of the patent foods is being used, 
it should be stopped and milk tried. If the milk is be- 
ing modified with barley or oat gruel, a cereal digestive 
may be substituted, like Cereo, and if this does not do, 
plain boiled water should be used. Whey or peptonized 
milk for a time may be tried until the digestive organs 
grow stronger. Patent food should not be resorted to un- 
less every other known alternative has failed; even a 
wetnurse, if a good one can be found, should be given a 
trial first. Milk of magnesia added to the formula, or 
given in a little hot water, may help also. Tablets or 
liquid cultures of the Bulgarian bacillus have helped colic 
in some very severe cases. To be of any real value these 
cultures must be absolutely fresh. Full directions for giv- 
ing them generally come with each box. 



INFECTIONS OF STOMACH AND INTESTINES 137 

Intestinal Parasites or Worms 

Worms are not nearly so common in childhood as the 
average mother supposes. It is wrong to treat a child for 
worms simply because he picks his nose^ has dark circles 
under his eyes^ or is a restless sleeper. 

There are three varieties of worms seen in childhood ; the 
tapeworm, the roundworm, and the threadworm. 

Causes, — Eating infected meat, fish, or playing with 
animals who have the little eggs of the worms in their 
skin, are the most frequent causes of worms in childhood. 

Tapeworm 

This worm may be fifteen or thirty feet long, and is 
made up of very little segments and a head, which are a 
dirty white in color. 

Symptoms. — The only positive symptom is finding the 
pieces of the worm in the stools. There may be bad breath, 
anemia, a great appetite, or sometimes a very poor one, 
attack of colic, or diarrhea. Sometimes there are no gen- 
eral symptoms. 

Treatment, — The child must have an empty stomach 
before the treatment can be begim; therefore, he should 
have a light supper of broth and a dose of castor oil the 
previous night. The next morning he must have no break- 
fast, but be given a capsule containing fifteen minims of 
male fern every hour, for four doses ; then one hour after 
the last dose a tablespoonful of castor oil must be given. 
Within the next few hours the worm will generally be 
found in the stools. Great care must be taken to hunt for 



138 DISEASES OF THE 0RGA:N"S OF DIGESTIOI^ 

the head of the worm^ for unless this is found the worm 
will grow again. 

Roundworm 

This worm is the one most frequently met with in chil- 
dren. It is pinkish in color and resembles the ordinary- 
garden worm^, but is pointed at each end; it is from five 
to ten inches long. Where one of these worms has been 
found others are nearly always present. They have a 
great tendency to wander^ and may get into the stomach, 
mouthy nose, ear, windpipe, and bile ducts. 

Symptoms.— There may be absolutely no symptoms, the 
worms being simply found in the stools, or there may be 
signs of indigestion, irritability, restless sleep, grinding the 
teeth, and other nervous symptoms, or even convulsions. 
It is important to remember that these signs do not in- 
variably mean worms. When worms are suspected the 
stools should be examined under the microscope for the 
eggs, and if any are found the treatment begun. 

Treatment, — The medicine must be given on an empty 
stomach the first thing in the morning in the same man- 
ner as in the case of the tapeworm. The drug most 
used is called santonin; this may be given with an equal 
amount of milk sugar, and should be mixed into a 
powder. 

Schedule for Dose 

MILK 

age santonin sugar 

Under two years 1 grain 1 grain 

Two to four years 1% grains 1% grains 

Four years or older 2 grains..... 2 grains 



INFECTIONS OF STOMACH AND INTESTINES 139 

Two hours after this a tablespoonful of castor oil may 
be given, and the child allowed to have a liquid food, as 
broth, about an hour after this. If worms are passed it is 
well to repeat the treatment in three days; then again in 
about one week if more are seen. This treatment for tape- 
worms and roundworms is weakening, and the child should 
be kept in bed while it is being given. A doctor should 
have charge of the child in both cases. 

Threadworms or Pinworms 

These worms resemble a short piece of white thread and 
are from one-third to one-half an inch long. They taper 
toward the tail. They are found chiefly in the rectum and 
lower part of the intestine, and many times may be seen 
about the anus and genital organs ; they are usually found 
in large numbers, and may be seen rolled in balls. They 
are very irritating and may cause a catarrhal condition 
of the lower bowel, producing much mucus. 

Symptoms, — The chief and most annoying symptom is 
itching of the anus and surrounding parts. This is al- 
ways worse at night when the worms are most active and 
come out of the intestine in large numbers to the sur- 
rounding parts. The child may wish to pass urine fre- 
quently, or have a white discharge from the vulva excited 
by the worms, or the bad habit of masturbation may be 
formed. Large quantities of mucus are often discharged 
from the bowels, and the rectum may even come down or 
prolapse. There may be some nervous symptoms, and 
even convulsions, but these are not so common as with the 
roundworms. 



140 DISEASES OF THE ORGANS OF DIGESTION 

Treatment. — Here we rely chiefly upon injections for 
treatment. The child should be prepared as for irrigation 
of the bowels {see pages 66-68), and a pint of warm 
water in which one teaspoonful of borax has been dis- 
solved, should be injected through a long rubber catheter. 
After this has all been passed, another injection of the 
same amount of either lime water, infusion of quassia, 
garlic, or a solution of bichlorid of mercury — one part to 
10,000 parts of water — should be retained for half an hour, 
the anus being held together so the child cannot expel it 
until the time is over. This should be done every other 
night at bedtime for about one week. If signs of the 
worms are still present, the castor oil santonin treatment, 
already described in the treatment of roundworms, should 
be given in addition to the injection. 

Bilious Attacks 

Before going further it may be well here to describe 
the *^T)ilious^^ attacks to which some children are so subject. 
The trouble is not alone in the stomach, but affects the 
tipper part of the intestines as well as the bile ducts. The 
inflammation extends from the upper intestine into the 
duct, which swells and causes jaundice. 

Symptoms, — The vomiting that occurs is the most dis- 
tressing symptom; it may be so severe as to greatly pros- 
trate the child. The bowels are at first very constipated, 
and when there is a stool it is very light colored, looking 
like clay. The urine is often very dark. The whites of 
the eyes and then the skin become yellow; there is some 
fever, loss of appetite, and in an older child often head- 



INFECTIONS OF STOMACH AND INTESTINES 141 

ache and dizziness. Children under two years of age 
rarely if ever have these attacks. 

Treatment, — While the vomiting lasts only water or 
Vichy should be given. No fats of any kind should be 
allowed and very little starches. Clear broths, absolutely 
fat-free, may be given in small quantities. It is best not 
to give milk for at least two days, and then to dilute it 
with lime water, or, better still, with Vichy; buttermilk 
may be taken with advantage. Orange juice and raw, 
scraped beef sandwiches may be given on the second or 
third day after the vomiting has stopped. No eggs, but- 
ter, or cream should be allowed for ten days or two weeks. 
The yellow color of the eyes and skin may be noticed for 
two weeks. 

For medicine it is well to give calomel in small doses. 

Schedule for Dose of Calomel 

Age Amount Time 

2 years 34 grain every hour, for 4 doses 

After 2nd year 34 grain every hour, for 6 doses 

The morning after the calomel either one teaspoonful 
of Eochelle salts in two ounces of water, or half a glass 
of citrate of magnesia should be given. Never give orange 
juice while calomel is being taken. To empty the bowels 
quickly a high enema is best, and will sometimes stop the 
vomiting more quickly. After the third or fourth day I 
like to give the rhubarb and soda mixture for a few days 
or a week. From one-half to one teaspoonful may be given 
three times daily. 

Children subject to these attacks should be made to 
drink a glass of water or Vichy before breakfast eaeli 



r 



142 DISEASES OF THE ORGANS OF DIGESTION 

morning; orange juice added to the water is often helpfuL 
Eich^ heavy foods, especially chocolate in any form, should 
be absolutely prohibited from the diet at all times, and 
eggs are best used sparingly. 



CHAPTEE VI 

DISEASES OF FAULTY NUTRITION AND GENERAL 
DISEASES 



Scurvy 

This is a disease more often associated with sailors 
than with babies^ in the minds of the laity; however^ it is 
not uncommonly met with in infants and it is due to the 
same general cause as in the case of sailors — lack of fresh 
food. 

Causes. — When a baby has had breast milk or correctly 
modified cow^s milk given raw^ there is very little chance 
of scurvy developing. It is usually caused by a patent 
food or by sterilized milk or sometimes by pasteurized 
milk. Patent foods^ especially if they are mixed with 
water^ and no fresh milk added to them, do not contain 
the correct elements for the proper growth of the baby, 
and scurvy often develops. Sterilized milk has been heated 
to so high a temperature that it is practically "dead food,'' 
hence it may cause scurvy, and the same is true of con- 
densed milk if it is used for any length of time. It most 
often occurs during the first year of life before the baby 
takes a varied diet. 

Symptoms. — About the first thing that a mother is likely 
to notice in a child with scurvy is that he often cries when 

143 



144 DISEASES OF FAULTY NUTRITION 

his diapers are being changed or whenever it is necessary 
to move his legs; this tenderness gradually increases until 
the baby cannot bear to be touched. There may develop 
some swelling around the joints or shafts of the long bones 
and often little hemorrhages apparently under the skin. 
The pain will frequently be so severe that the child will 
hold his legs almost rigid^ acting as if he were paralyzed. 

A very characteristic symptom is the condition of the 
gums. In the mild cases they are swollen and brighter 
red with a dark reddish or purple line near the teeth, if 
the child has cut any. In bad cases they are dark red or 
purplish and very soft and spongy; later they may ulcer- 
ate. On close examination tiny hemorrhages may be seen 
in the gums. 

As the case advances, minute hemorrhages may be seen 
under the skin in other parts of the body — under the 
eyes, or on the thighs — and there may even be hemorrhages 
from the nose, mouth and stomach. 

By persons who have not treated many babies this dis- 
ease is often mistaken for rheumatism or a form of paraly- 
sis. Eheumatism very rarely occurs in a baby under two 
years of age, and the gums are not involved. 

In cases of paralysis the legs cannot be moved at all 
by the child himself, while in scurvy it is possible for him 
to move them but simply painful. When taken in hand 
early and correctly treated scurvy may be cured in a few 
days or a week but if it has been wrongly treated, for rheu- 
matism or paralysis, it may take weeks and months to 
finally cure the child, or death may result. 

Treatment, — The treatment is almost entirely dietetic. 
If the child has been fed on a patent food or sterilized 



SCURVY 145 



milk these must at once be stopped^ and cow^s milk, given 
Taw but diluted with water or a gruel if the child is under 
one year of age, must replace them. In addition to this 
beef juice and orange juice should be given. Even a young 
haby may take one ounce of orange juice between meals, 
a teaspoonful at a time if necessary. Beef juice may be 
given in the same amounts. A child over one year of 
age may take one-half to one ounce at a time of beef 
juice, and orange juice three or four times daily. 

Generally the change in food is all that is needed, and 
at the end of twenty-four hours the improvement is 
marked. By the third or fouth day very little pain will 
be noticed and the recovery is then rapid. 

Later the child may need an iron tonic like hemaboloids 
or peptomangan which will help to build him up more 
quickly. Plenty of fresh air and sunshine is needed al- 
ways. 

Marasmus — Malnutrition 

Marasmus is a general wasting without any special 
known cause. It is seen during the first years of baby- 
hood, or early in the second year. It is rare in breast- 
fed babies unless the mother cannot supply them with 
really nourishing milk, but very common among bottle- 
fed infants, especially among the poorer classes. 

Causes. — ^No one distinct cause has yet been found to 
explain marasmus. It may occur in babies who inherit a 
weak constitution or have been badly fed; then again it 
may be seen in infants who have had the best of food 
and care. We can only regard this as some kind of an 
affection or poisoning that takes place through the stomach 



146 DISEASES OF FAULTY NUTKITION 

or bowels and produces the general wasting. Babies in 
hospitals and institutions are very apt to develop this 
disease if they are kept there any length of time — it is 
then spoken of as *^^hospitalism/^ 

Symptoms. — K typical marasmus baby is a pitiful pic- 
ture. At first only continued loss in weighty with nothing 
that can explain it^ can be found. As time goes on the 
fontanel becomes depressed; all the superficial fat dis- 
appears ; the face becomes pinched and drawn^ with a very 
worried old look, which makes the child appear like a little 
old man or woman. The skin hangs in folds on the body 
and is dry and easily irritated and full of wrinkles; the 
abdomen becomes distended and prominent, and the intes- 
tines usually full of gas. The child literally wastes to a 
skeleton and becomes weaker and weaker until he dies, or 
more rarely gets better. There is generally a very large 
appetite, the child being very hungry, because the food it 
takes does not nourish it. The stools are very variable; 
sometimes they are green, again yellow or brown; some- 
times loose, sometimes constipated, but they usually show 
some undigested food, although at times a perfectly nor- 
mal movement will be seen. Nearly always, however, they 
will have a very bad color. The child is usually very rest- 
less and very fretful, acting as though hungry much of 
the time, and sucking its fingers or anything else it can 
reach. His head may at times be thrown away back," and 
the neck stiff, so that one might fancy he had some grave 
brain trouble. His hands and feet are nearly always cold, 
his temperature below normal, and the child very pale, 
with deep lines around his mouth, which is sometimes al- 
most blue. Death may take place slowly and from the 



MARASMUS— MALNUTRITION 147 

general wasting alone, or there may be convulsions or some 
complicating disease. A few cases recover, but it takes 
many months as a rule. These marasmus babies, however, 
when they do recover, are as well as other children. I have 
in mind a number now who have become unusually well- 
developed and plump children. 

Treatment, — This lies more with the mother than with 
the doctor; no detail is too small to be considered in tak- 
ing care of such a child. A complete change of air is 
sometimes helpful. If one lives in the city a change into 
the country may help and give the baby a needed start. 
Personally I have found that these babies do much better 
in the inland country or moderately high mountains, than 
at the seashore where there is always more or less damp- 
ness. As much time as possible must be spent out of doors, 
but in winter care must be taken not to let the child get 
chilled in his carriage. A hot water bag should be a 
pretty constant companion of a marasmus baby. The 
child's position in his crib or carriage should be often 
changed so that bedsores will not develop; these are very 
apt to occur. If they have, the mother should make a ring, 
like a doughnut, of cotton, and wind a bandage around it 
to keep it in place, keeping it over the sore parts, so that no 
further pressure can be made upon the sore. The latter 
must be bathed gently and a dusting powder of bismuth 
or aristol kept on it, or a little flexible collodoin. 

Unless exceedingly weak these babies need a lukewarm 
tub bath every day, and a sponge bath in the evening at 
bedtime. A dash of cold water down the spine, followed 
by a gentle but brisk rubbing, may help the circulation 
a little, but if the baby gets blue and not red after this 



148 DISEASES OF FAULTY NUTRITION 

treatment it should not be repeated. Massage with olive 
oil or cocoa butter after the bath is also helpful^ and is 
quite as beneficial as cod liver oil rubs. The latter are so 
disagreeable;, and stain the clothing so badly, that it does 
not seem wise to use them when other things will do as 
well. 

Thrush or sprue is so apt to develop in these cases that 
the most scrupulous care must be given the mouth, and all 
things used in preparing the bab/s food. The baby^s 
mouth should be gently washed with a saturated solution 
of boric acid after each meal. The rubber nipples must 
be frequently renewed and scrubbed inside and out with 
scalding water and a brush every day. After each bottle 
they must be well rinsed with cold water^ and kept in a 
covered glass containing a pinch of borax or bicarbonate 
of soda. The nursing bottles must be rinsed with cold 
water at once on becoming empty, a pinch of bicarbonate of 
soda added, and once daily they must be washed with soap 
and water and a bottle brush and then well boiled before 
the fresh food is put into them. 

The nursery must be the largest and best ventilated 
room in the house; plenty of sunshine and fresh air are 
essential in the house as well as out of doors. In cool 
weather sun baths are helpful. The baby^s eyes must be 
protected from the glare, and the whole of the body ex- 
posed to the sun^s rays for a half an hour or so at a time. 
If the room can be made warm enough the bath may be 
given without clothing, but if not, then the clothes may be 
left on and the sun bath given in this way. 

The bowels must be well looked after. Every week at 
least it is a good plan to give a teaspoonful of castor oil. 



MARASMUS- MALNUTRITION 149 

An occasional dose of milk of magnesia should also be 
given, or high rectal irrigations of lukewarm salt and 
water, one teaspoonful of the salt to a quart of water. 
These measures help to clear the intestines of any poison- 
ous material, and get them ready to absorb fresh food. 
Great care must be given to the buttocks, as they very easily 
become chafed ; after each movement they should be washed 
with olive oil, and a pure talcum powder or stearate of zinc 
dusted on, or else a salve composed of two teaspoonfuls of 
oxid of zinc, two teaspoonfuls of starch, one ounce of vase- 
lin — all well mixed and spread on soft linen. The diapers 
themselves must be very carefully washed and boiled, then 
hung in the air and sun to dry. 

It is almost impossible to lay down any rule in regard 
to the food itself : what will suit one baby will not suit 
another. A good wetnurse is sometimes the only solution 
of the feeding problem. Absolute regularity must be ob- 
served; there is no more fatal mistake than to overfeed a 
marasmus baby because he seems hungry and chews his 
hands. A little food that is assimilated will do much more 
good than a quantity that cannot be absorbed but must be 
left in the intestines to poison the child. A three-hour 
interval should be the rule, and the modified milk formulas, 
as given on page 20^ should be tried, beginning with a 
dilute formula and working up little by little ; should this 
not prove satisfactory, two or three ounces of a strong for- 
mula may be tried. 

Sometimes these babies can digest a liWe of a strong 
food better than they can a larger amount of a weak 
formula. Each individual baby differs here, and only pa- 
tient experiment can bring results. These babies often 
11 



150 DISEASES OF FATTLTY yrUTEITION 

do better on the plain milk mixtures than on the high 
cream mixtures^ and it is often better to use some cereal 
than boiled water as a diluent. This cereal may be dex- 
trinized if it is found that the child digests it better, or 
some form of malt may be added. Protein milk often gives 
these babies a start (see page 28). 

Beef juice and orange juice may also be given^, and 
when the child is a year old bacon may be sucked. A 
coddled egg, given in very small quantities at first, may be 
tried with a baby over nine months old ; or half a raw egg 
may be stirred up in the baby's bottle once daily if it causes 
no signs of acute indigestion. Our aim to give all that 
can be absorbed, but no more, must be kept in mind. 

A marasmus child will often do much better when it 
can take food other than milk, hence these babies may be 
given semisolids a little earlier than the average normal 
child. Broths well cooked, cereals, coddled egg, zwieback 
soaked in milk or water, may be begun in small quantities 
after the ninth month, and raw scraped beef, only a tea- 
spoonful at a time, may be tried with an eleven-months- 
old child. The stools must be carefully watched, however, 
and if the food is passed much undigested, this semisolid 
diet should not be repeated for some time at least. 

It should not be supposed that drugs will cure a maras- 
mus baby; almost without fail they will simply upset the 
stomach and do no good. Iron, cod-liver oil, and such 
medicines may aid the child after the proper food has 
really begun to make him gain a little, but food absorption 
must have taken place first. Water given between meals 
is quite necessary, and should not be forgotten. Diarrhea, 
constipation, colds, bronchitis, etc., that occur in the 



RICKETS 151 



course of marasmus^ should be treated as in any other 
case of the same disease. 

Rickets 

Rickets is a chronic disorder of the entire body caused 
by disordered nutrition. In many cases disease of the 
bones is most evident but other parts of the body are« 
also much affected. Rickets usually occurs from the sixth 
month to the second year of a child^s life. 

Causes. — Two classes of people especially among the 
poor are prone to have rickets : these are Italians and ne- 
groes. For many years rickets was called the English 
disease, as it was most often seen in England, and very 
seldom in the United States. Errors in diet are the cause 
of rickets; bad surroundings, lack of fresh air and sun- 
shine, also greatly help the disease to develop. Breast-fed 
babies who have been nursed too long or whose mothers 
are delicate and give them a poor quality of milk, often 
develop rickets. Bottle-fed babies fed on patent foods, con- 
densed milk, or a poor quality of cow's milk wrongly modi- 
fied, are frequent victims. There is some element lacking 
in the food of rachitic children — what it is can only be 
found out certainly by having the food analyzed, and the 
results compared with normal breast milk, which is the 
food intended by nature for the baby. 

Symptoms. — The symptoms of rickets are so many and 
varied that it is best to describe a child who has nearly all 
of them, but it must be remembered that in some cases the 
entire group of symptoms may not be present. Let us take 
for example a baby developing rickets : 

At birth the baby is apparently normal, plump, and well- 



152 DISEASES OF FAULTY NUTEITION 

nourished^ with good color. As time goes on the color 
fades and the baby becomes pale^ although he may not get 
thin. When the time arrives for a baby to begin to hold 
up his head this child will make no attempt to do so ; his 
muscles are too weak and flabby to make this possible. 
He is equally backward about trying to sit, stand, and 
walk alone. In time he will no doubt accomplish all 
these little feats, but he is months behind the average 
child. I have seen many rachitic children who could not 
walk at the age of two years. There is generally a strong 
tendency to constipation; the skin is easily irritated; the 
baby perspires very easily, especially in his sleep — the pil- 
low may be very wet after a nap. These babies are very 
apt to be fretful and restless sleepers. 

Generally when a baby is six or eight months old the 
distinct rachitic signs in the bones may be seen. The 
£rst of these is usually the little lumps or ^^beads^^ on the 
Tibs: a whole row or chain of these can be felt and soon 
plainly seen, and they are generally called ^^the rachitic 
Tosary.^^ At the wrists, knees, and ankles, the ends of 
the bones soon become enlarged, resembling knobs. The 
shape of the head assumes a peculiar form; it is very 
large in proportion to the rest of the body, being rather 
square, very flat on top, with bumps on the sides and 
upper part of the forehead. The fontanel, instead of 
showing a tendency to close as the baby reaches his eight- 
eenth month, remains wide open until a very much later 
period — sometimes until the child is three years old. There 
are often soft spots in the skull at different places. The 
teeth are very late in coming; many times none appear 
until the child is a year old ; then they decay early. 



EICKETS 153 



Little by little the soft yielding bones become molded 
out of shape so that the chest assumes a typical form 
often known as ^^pigeon breasted/^ or the shape may re- 
semble a violin^ and the child may be said to have a 
^^violin chest/^ The spine is soft and easily bent out of 
shape^ as all the ligaments and muscles are weak as well 
as the bones; the back may be therefore much bent^ or 
the spine appear crooked^ but it is not rigid and can 
be overcome by bending the child backward when he is 
still young. A little later the child develops bow legs 
or knock knees, or both. The arms may be bent very 
much like the legs. The bones of the pelvis also often be- 
come pressed out of shape but are not noticed much at this 
time. If the child is a girl this may give rise to serious 
trouble if she ever becomes pregnant in later life. One of 
the most striking symptoms is the appearance of the abdo- 
men : the muscles are so weak they easily become stretched, 
and the abdomen is distended and bulges very much so 
that one might think the child to be very fat and plump, 
but in reality he is thin. 

The mucous membranes as well as the bones and muscles 
are weakened by rickets and very irritable, so that the 
child is exceedingly likely to have bad colds, catarrh, bron- 
chitis, pneumonia, intestinal disturbances, and stomach 
troubles. The ordinary infectious diseases of childhood 
take a much stronger hold on a child already weakened by 
rickets. Numerous nervous symptoms are seen; spasms 
and even general convulsions are not at all rare, although 
they do not invariably occur. 

After a child has reached the age of two years the 
tendency is to recover from rickets slowly, as he then 



154 DISEASES OE EATJLTT NUTEITION 

eats a greater variety of food; but if the deformities are 
marked in the bones these may remain the same through- 
out life. 

Treatment, — As prevention is so much better than cure^ 
every mother should do all in her power to understand the 
principles of infant feeding, and so not allow her baby to 
develop rickets through ignorance on her part. 

When the disease has set in, however, and has been recog- 
nized, much can be done to stop its progress. In the first 
place the food must be changed. The breast-fed baby must 
have an analysis made of the milk, and whatever element 
is lacking must be supplied according to the rules already 
laid down on page 109. If the mother still wishes to nurse 
her child and the milk shows any signs of improving 
she may continue to do so a while longer, if she alternates 
her breast milk with a good formula of cow's milk. 

If the child has reached its tenth or twelfth month it 
will be found best not to waste time in trying to build up 
the breast milk, but to wean the child and give him modi- 
fied milk and other articles of diet suited to his age, such 
as beef juice, orange juice, coddled Qgg, clear mutton and 
chicken broths, and cereals cooked several hours. Broiled 
bacon to suck may also be given a year-old child with 
benefit. As bottle-fed babies who develop rickets are usu- 
ally being fed on either condensed milk or some proprietary 
food, these foods must be stopped at once and either cow^s 
milk properly modified or plain should be substituted if 
the child is over one year old. It is best not to pasteurize 
the milk, if reasonably pure milk can be found. 

The daily life of the rachitic child must be carefully 
regulated; he must be treated with great regularity, and 



EICKETS 155 



an exact schedule should be followed. He must sleep in 
well-ventilated rooms full of fresh air and sunshine^, and 
yet he must be protected from direct draughts. He must 
spend every minute possible in the fresh air, and on days 
with high winds, or when it is below 20° F. and damp, he 
should be given a regular airing in his nursery, dressed as 
for going out of doors, and with the windows lowered 
from the top. The baths must not be given too warm, 
as there is greater danger of catching cold after them. 
The child may be placed in the tub with the water at 
98° F. and cold water gradually added until it reaches 
90° F. Sea salt dissolved in the bath water (one cupful to 
each gallon) is good, and often beneficial for an irritated 
skin or excessive perspiration. 

Besides the daily bath the child should have a sponge 
bath on retiring. A good rubbing, or better still, massage, 
should be given after the bath to stimulate the circulation. 
A little cocoa butter may be used on the hands for this 
rub. Constipation should be treated as described on pages 
131-133, and other conditions as they arise. 

Food and good hygiene are, of course, the chief factors 
in treating rickets, but if the child's stomach can stand 
them a few medicines may help along a little. Only one 
thing should be given at a time, however. In cold weather 
some preparation of cod-liver oil may be tried. I rather 
like the maltine with cod-liver oil, as this helps to over- 
come constipation a little also. One or two teaspoonfuls 
three times daily are usually given, but this mast be 
stopped if there is the least digestive disturbance. Phos- 
phorus is given by some, but I have never seen any very 
marked results from it. The syrup of hypophosphites of 



156 DISEASES OF FAULTY NUTRITION 

lime and soda without strychnin may help at times. For 
pallor or anemia, a tonic with iron in it, like hemaboloids 




Fig. 15. — Shoe to Prevent or Cure Bow-legs in Children. 
(By courtesy of Best & Co., New York.) 

or peptomangan, is beneficial. It is a good plan to alter- 
nate with the above-mentioned medicines so that one is 



Fig. 16.— -"Toe-in" Shoe. (By courtesy of Best & Co., New York.) 



EICKETS 15 



used for a month or so, then another taken; but oils mu.s. 
not be given in hot weather. 

For the bow legs try shoes especially made for this con- 
dition; they are built up on one side of the sole and help 
mild cases. For the severer forms braces may help some, 
but where the deformity of arms or legs is very marked and 



Fig. 17. — Ankle and Arch Supporting Shoes. (By courtesy 
of Best & Co., New York.) 

does not show a tendency to improve at all a surgical op- 
eration will be found to be the only means of relief, and 
as this is not a serious one, it is the duty of the parents 
to have it performed. It will alter the child^s life in later 
years and prevent much suffering. Other deformities of 
the legs and feet may sometimes be helped by shoes like 
those shown in Figs. 16 and 17. 

Rheumatism 

Eheumatism is so painful and many times so serious a 
disease that all parents who have had it are most anxious 
that their children should escape this inheritance. 

Causes, — In a very large percentage of cases the dis- 
ease may be traced directly to former generations : hence 
this inherited tendency is one of the chief causes of rheu- 
matism. Exposure to dampness and cold will also cause 



158 GENERAL DISEASES 

rheumatism^ especially where the child has a tendency to 
it. Children under five years of age are not apt to have 
this disease, and cases under three years of age are very 
rare; therefore when a child under this age has sore joints 
and cries with pain when handled, the mother should not 
at once think of rheumatism — a young baby affected in 
this way in all probability has scurvy and not rheumatism. 
Strange as it may seem, even physicians will frequently 
mistake these conditions. 

Prevention and Treatment, — In a family with rheu- 
matic tendencies the baby should be carefully guarded 
from the very first, for although he will not show any 
symptoms of the disease during the first few years of his 
life it may appear in full force later in life. 

He should not be loaded down with red flannel and kept 
in the house all the time, but should wear medium-weight 
flannels in winter and very light-weight ones in summer. 
Exposure to dampness should most carefully be avoided, 
but on sunny days the child should remain outdoors as 
much as possible. He should get plenty of pure air and 
oxygen in his lungs and not be kept in close, stuffy rooms 
filled with tobacco smoke and stale air which has already 
been breathed many times by grown people. 

In regard to food for the young baby : proprietary foods 
should be avoided and either good breast milk or cow^s 
milk properly modified should be given. As the child 
grows older it is best to avoid much beef juice, red meat, 
and sweets, as these foods do not agree very well with 
children who have a strong tendency to rheumatism. Such 
children should be taught to take cereals without sugar, 
fruit juices, vegetables, and vegetable purees for soups in 



EHEUMATISM 159 



place of animal broths. A little broiled or baked fresh fish 
once a week in place of so much meat is a good plan to 
follow; if perfectly fresh, either clam or oyster broths may 
be given occasionally when in season and will make a 
-pleasant variation with the vegetable purees. Zwieback and 
stale whole wheat bread should be given in preference to 
crackers in large quantities, and cake and candies should 
be forbidden except in very small amounts as a rare treat. 
There has been prepared a fine flour made from a prepara- 
tion of beans; it is called legume flour and is exceedingly 
nourishing, easy to digest, and when flavored with a little 
bacon it is very palatable; with an older child it may be 
given as a soup, and with a young baby as a gruel. Milk 
and cocoa may be taken, but chocolate must be avoided 
here as with other children, as it is too rich and easily 
upsets the stomach. Buttermilk may be used. 

Plenty of pure, fresh water must be given, and until 
the child is two or three years old this should be boiled. 
It is best to give it between the regular meals. Great care 
must be taken to keep the bowels regular and the kidneys 
in good working order. If the urine passed looks at all 
dark, or leaves a stain on the napkin, a specimen should 
be sent to the doctor for examination. Such children 
should never be allowed to become constipated. They 
should be trained to have a regular movement of the 
bowels each morning at a fixed time. The use of a small 
chamber may be begun as early as the second month. It 
should be placed in the mother's lap and the baby sup- 
ported by her and held on the small chamber. A mother 
from Scotland wrote to me a short time ago that all babies 
in her country were taught this at a very early age. She 



160 GENERAL DISEASES 

said that one of the very first things the nurse asks for 
is a small chamber and some Canton flannel to make a 
little ring to place over the rim of the vessel. She also 
said that constipated babies in Scotland are very rarely 
seen^ and that this is probably due to the great care taken 
in making them form a regular habit of moving the bowels 
at a certain time each day and to the position taken when 
they are held on the small chamber. 

An older child may use the nursery chair until he is 
about two years old; then it is best to teach him to use a 
small seat which may be placed on the closet^ but his feet 
should be supported by means of a box or other contriv- 
ance and not allowed to dangle in the air. 

All this is not at all impossible or even very difficult 
to teach the average child. It requires a little patience 
at firsts but in most cases it can be accomplished^ and a 
great deal of time and trouble will then be saved both 
mother and child. Well-trained babies nowadays are not 
supposed to soil their napkins after the second month, nor 
do they, and in some instances they cease even earlier. 

The above advice on constipation has a great deal to do 
with the successful care of children who inherit a tendency 
to rheumatism, for if a child is constipated all the poison- 
ous substances remain in the body and get into the sys- 
tem instead of being thrown off as they should be, and 
rheumatism is to a great extent a poison. 

Often children with rheumatic tendency will have sore 
throats from no apparent cause. The throat is often 
swollen, red, and quite painful, and is made worse by 
exposure to cold or damp. A child with such a sore throat 
will do much better and recover much more quickly if 



EHEUMATISM 161 



he is put to bed for a day or two^, so that there is no 
danger of draughts from sitting on the floor or running 
about in cold halls. The temperature can be kept much 
mor^ even and the child can be made contented with a few 
toys and books and propped up with pillows so as to be 
comfortable. He should also wear a little flannel jacket 
over his nightdress when the upper part of his body is 
outside of the bedclothes. 

Eheumatic children frequently have ^^stiff neck/' and 
they often suffer a good deal of pain from this. They 
should be taken to a good physician and receive the 
proper treatment and not be experimented with at home, 
rubbed with patent remedies^ etc. These children are also 
subject to various red rashes which come and go without 
apparent cause and are often a puzzle to the mother and 
even to the physician if he has not made a careful study 
of the little patient and his family history. 

^•Growing pains^' are also very prevalent among this 
group of little patients, and they should not be ignored, 
for many times they are the forerunners of very painful 
attacks of rheumatism ; and as the heart is so apt to become 
affected where there is rheumatism, serious trouble may 
begin before the mother is aware of it. 

Children with a rheumatic tendency frequently have 
chorea, or what is commonly known as ^^St. Yitus's dance'' ; 
hence they should never be forced and pushed in school; 
and at the first sign of this trouble they should be taken 
out of school and be made to live a quiet life in the coun- 
try, if possible, until all disagreeable symptoms have 
ceased. 

From what has been said it will be seen that the vorv 



162 GENEEAL DISEASES 

earliest signs of rheumatism in children are not at all 
like those in grown people. Mothers should be on their 
guard in caring for their children if there is a history 
of rheumatism in the family; when the child actually has 
the disease he should at once be taken to a doctor and be 
very carefully watched by the latter. It is not the disease 
itself that is so very dangerous, but trouble with the heart 
may at any time set in, and when this once gets started it 
can never be entirely cured. 



CHAPTEE VII 

MOST COMMON DISEASES OF THE RESPIRATORY 
SYSTEM 



DISEASES OF THE NASAL CAVITIES 

Nosebleed 

Nosebleed in infancy^ except in children who have 
syphilis^ is rather a rare disease^, but in older children it 
is rather common; boys are more subject to it than are 
girls. Girls, however, often have severe nosebleeds about 
the time they mature. 

Causes. — Delicate children who have been fussed over 
too much and who have not had enough fresh air often 
have nosebleed. It often occurs with the contagious dis- 
eases, and with anemia or diseases of the heart and blood 
vessels. A knock or blow or picking at the nose may 
often bring on a nosebleed; in nervous children any great 
excitement may cause it. 

Symptoms. — Sometimes a child can tell when he is 
about to have a nosebleed by a feeling of fullness in his 
head, and may be relieved when the bleeding takes place. 
The blood usually comes rather slowly and from one nos- 
tril, although it may come from both. The bleedmg 
usually lasts from ten to thirty minutes. 

163 



164 DISEASES OF EESPIRATOET SYSTEM 

Treatment. — This depends somewhat upon the cause. 
If the child is run dowa and miserable he should be built 
up by means of nourishing food and fresh air^ and if at 
school, should be given a leave of absence for a time and 
made to live out of doors as much as possible. Foods that 
contain iron^, such as spinach, carrots, grape juice, grape 
and cranberry jellies, are of benefit if the child is anemic. 
Iron given in easily assimilated forms, as hemaboloids and 
peptomangan, may also be needed. 

For the bleeding itself the child should be made to keep 
perfectly quiet, sitting up, and the nose held between the 
thumb and finger while ice is placed over the base of the 
nose and cool cloths or ice wrapped in cotton applied over 
the nape of the neck, or a small piece held in the mouth. 
All tight clothing, especially collars, should be loosened. 
The old-fashioned remedy of dropping a key down the 
back is not a bad one. Packing soft paper under the up- 
per lip in a firm, wad and holding the arms above the head 
may also be tried. If all the above measures are of no avail, 
a physician will have to plug the nostrils. The child should 
be cautioned not to blow his nose for some time after a 
nosebleed, as this is liable to bring on another attack. 

Foreign Bodies in the Nose 

Children often put buttons, peas, or other small objects 
up the nose. The mother should hold the free nostril 
firmly and then make the child blow hard, so that all the 
air will be forced out of the inside where the object has 
lodged, and the article itself dislodged. If this does not 
help a doctor should be called, for if the mother pokes at 
the article she is apt to push it further back. 



DISEASES OF THE NASAL CAVITIES 165 

Acute Rhinitis, Acute Catarrh or ^'Colds" 

This is one of the common diseases of the respiratory 
system found in children. 

Causes, — A tendency to this condition is often inherited 
either from one or both parents; again it originates with 
the child himself, because he is treated like a little hot- 
house plant by an overanxious mother who keeps him in 
a hot, close room, afraid of every breath of fresh air. Be- 
ing dressed too warmly is another cause of this frequent 
disease. Children exercise a great deal and then perspire 
if they are loaded down with too much clothing — the least 
draught is then felt on the overheated body; the child be- 
gins to sneeze, and he has "caught cold^^ or has acute 
catarrh. Sometimes children who are rachitic have a 
series of attacks of catarrh until it becomes chronic in 
form. Again, young babies, who are teething, may have 
this disease frequently. Enlarged tonsils and adenoid 
growths are often both a cause and a result of catarrh, the 
secretions being retained by these little bodies, and in 
this way causing a recurrence of attacks. After the re- 
moval cf the growths, the child has fewer colds. 

One form of acute catarrh is undoubtedly contagious, be- 
ing caused by a little germ ; if, for instance, one child in a 
family has an attack and another child uses the same 
handkerchief there is great probability of the second child's 
contracting the disease, or if susceptible, he may contract 
it by simply being in the same room near the affected 
child. I have seen this disease run through an entire 
family. Sometimes it is difficult to tell an attack of acute 
catarrh from measles in its earliest stage, for the latter dis- 
12 



166 DISEASES OF RESPIEATORY SYSTEM 

ease begins by a more or less profuse discharge from the 
nose and eyes. 

Symptoms. — The symptoms of acute catarrh are known 
to every mother. There is a rather thin discharge from 
the nose and often from the eyes; that from the nose 
usually grows thicker gradually^, the nose being very much 
stopped up^ the child having to do most of his breathing 
through his mouth. Sometimes the obstruction is so great 
that nursing is seriously interfered with^ for the baby can- 
not nurse and breathe through his mouth at the same time. 
The nostrils and upper lip are often chafed by means of 
the discharge, there is frequent sneezing, and sometimes 
slight fever, the temperature seldom going over 102° F. 
unless the attack is an unusually severe one, or is com- 
plicated by some other condition. If the throat is exam- 
ined it will usually be found more red than normal; the 
eyes may also look rather red and even a little swollen, 
while there is frequently a slight deafness if the inflam- 
mation extends into the eustachian tubes. There may be 
even an earache, and later a discharge from one or both 
ears. Hoarseness and some cough are frequent symp- 
toms. In the case of babies and children too young to 
expectorate, mucus will be found in the stools, and some- 
times vomiting will be caused by the excess of mucus 
secreted. 

The mild form of acute catarrh lasts from one to two 
days, and the severe form from one to two weeks. If the 
discharge is tinged with blood the mother should at once 
have a culture of it taken, and examined under the micro- 
scope by a reliable doctor, for in such a case there may be 
nasal diphtheria present without the mother suspecting it ; 



DISEASES OF THE NASAL CAVITIES 167 

even doctors cannot always tell without this test by the 
microscope. 

Treatment. — The treatment of acute catarrh differs 
somewhat with the season of the year and with the severity 
,i the attack. It is generally best;, however^ to keep the 
child in the house in a room which can be kept at 70° F.^ 
but not warmer. The room should be well-ventilated by 
having the window lowered for at least a short time every 
day, but all direct draught should be avoided with much 
care; hence it is much wiser not to allow the child to sit 
on the floor while at play. 

One or two teaspoonf uls of castor oil is an excellent thing 
to give at the beginning of an attack ; it clears the bowels 
and carries off a good deal of the excess of mucus. Great 
care must be taken to keep the child's bowels open every 
day in this condition more than in any other, if he is 
inclined to be constipated. After the dose of castor oil 
milk of magnesia or some other mild laxative may be 
given each day for a short time while the attack lasts. 

In spite of the old adage, ^"^stuff a cold and starve a 
fever/' it is better to reduce the baby's food a little at this 
time. If he is a bottle-fed baby, pour out an ounce of 
his regular food and add in its place an extra ounce of 
boiled water, or if an older child, keep him on only such 
articles of food as it has been found he can most easily 
digest. While there is fever all solid food should be aban- 
doned and only a diet of milk and broths used. 

Medicine is of little value in treating this disease. 
Sometimes, if given at the very onset of an attack, rhinitis 
helps a little. The half-strength variety should be used 
for children under ten years of age and only half of one 



168 DISEASES OF RESPIEATOEY SYSTEM 

of these tablets be given a child under three years of 
age^ every hour. It is best to depend on outward treat- 
ment, and the above-mentioned castor oil for babies under 
a year old. 

To cleanse the nose and soften the secretions that may 
have formed, warm sweet oil or liquid albolene may be 
used. These may be applied either by means of a small 
piece of absorbent cotton very firmly twisted on the end 
of a wooden toothpick, or a regular albolene spray may 
be used. The nose may be treated in this way three or 
four times a day if the discharge is very profuse. A 
little vaselin or boric acid ointment should be rubbed 
around the nostrils and upper lip to prevent or cure the 
chafing. If it is absolutely necessary to syringe the child's 
nose in order that he may nurse, a doctor or nurse should 
show the mother how to do it, as this is best taught by 
an object lesson, and may cause a good deal of pain if 
not properly done. When a cough is present the inhala- 
tions of steam {see pp. 74-77) should be tried and not 
cough mixtures that may upset the stomach. 

Other treatment for coughs will be given later. 



DISEASES OF THE THROAT 
Chronic Catarrh, Adenoids, and Enlarged Tonsils 

Causes, — Frequent attacks of acute catarrh, inherited 
tendency, or careless hygiene and large adenoids or tonsils 
are the usual causes of this disease. 

Symptoms. — When a child has chronic catarrh there 
will generally be noticed an odor issuing from his nose 



DISEASES OF THE THROAT 169 

or mouth: this is especially noticeable in the morning 
when he arises. 

The discharge seen in these cases is thicker than that 
noticed in the acnte form, and unless the child is old 
enough to frequently clear his nose by blowing it, he is 
usually exceedingly uncomfortable the greater part of 
the time. It is in this form of catarrh more than any 
other that one may fear deafness from the gradual ex- 
tension of the inflammation through the eustachian tubes 
into the ear. Many a deaf man or woman has his mother 
to blame for neglect in procuring the proper treatment 
for catarrh when he was a small child. It is often thought 
that the child will outgrow catarrh, and nothing is done 
for it with the exception of giving cod-liver oil or iron to 
build him up, when the root of all evil is usually adenoids, 
and is left untouched. 

Treatment. — -First of all, therefore, when a child has 
chronic catarrh, he should be taken to a throat specialist 
and a thorough examination made of both nose and throat. 
If adenoid growth or enlarged tonsils are found, they 
should be removed by an experienced person as soon as 
possible. If deafness once gets a good start it is very 
difficult to arrest its progress. While the removal of 
adenoids has been practiced in the last twenty years more 
frequently than it once was, it is by no means a fad, as 
some foolish people tell the young mother. No conscien- 
tious physician would advise having these growths removed 
unless he considered it absolutely necessary for the child's 
best growth and development. The enlarged tonsils and 
adenoids prevent the proper amount of air from getting 
into the child's lungs and aeratins: his blood. He is there- 



170 DISEASES OE RESPIRATORY SYSTEM 

fore a pale^ delicate looking little person, with hollow 
•chest, and, most frequently, widely open mouth. He is 
nervous in the day time, and a poor or restless sleeper 
at night, especially subject to all the diseases of infancy 
and childhood. After the nose and throat have been 
properly freed for the passage of air by the removal of 
these growths, one would scarcely recognize the child: 
his color is much improved, he sleeps well, breathes through 
Lis nose, his lungs begin to expand, his chest to develop, 
and he is an entirely different sort of a person than he 
was before the operation. 

While a spray of some sort is useful in cleansing the 
nose and throat in cases of chronic catarrh, it will never 
result in a cure if the enlarged tonsils and adenoids are 
fitill in place. 

As previously mentioned, children are very apt to put 
small objects, such as buttons or peas, up their noses. If 
these small bodies remain in the nostrils for some 
time without being discovered, they set up a discharge, 
which is really a form of catarrh. The discharge in such 
€ases is often quite thick, and sometimes very offensive 
looking — in many cases like thin pus. The mother should 
take her child to a specialist who has the proper instru- 
ments to examine the nose and remove any foreign body 
that may be found there. 

Another cause of chronic catarrh is little nasal poljrpi; 
however, these are not so very common in early childhood. 
Children who have frequent attacks of asthma have these 
little polypi in their noses in many instances. In damp 
weather these polypi swell a good deal and cause much 
suffering, causing the child to feel as if he were suffocating. 



DISEASES OF THE THROAT 171 

He is also often troubled with headache^ and sometimes 
his sense of smell or taste and hearing are impaired. The 
discharge in these cases is not so profuse as in the other 
forms of catarrh^ and does not look like pus. The only 
treatment for these growths is their complete removal by 
a physician. 

In addition to the above causes and forms of catarrh 
there are some congenital defects in the nose which may 
be mentioned^ bnt need not be discussed here, as it would 
be almost impossible for anyone but an experienced physi- 
cian to detect the errors or remedy the defects. 

In closing this most important subject of catarrh of 
the nose I cannot too strongly urge the mothers who 
have the good of their children at heart to have the proper 
treatment given them as soon as the first sign of trouble 
in this direction is noticed. 

Follicular Tonsillitis 

Causes, — This is seldom seen in infancy^ but is often 
met with later in childhood, especially among children 
who are rather delicate and who have enlarged tonsils. 
Eheumatic children are very apt to have it. If there is a 
predisposition to tonsillitis a chill or a slight cold will 
usually be enough to bring on an attack. 

Symptoms. — An attack of tonsillitis usually begins sud- 
denly. There may be a chill or simply a high fever ; this 
often runs as high as 102° or 103° F. The bowels are 
apt to be constipated, and the child complains of general 
aching of all the bones, muscles, and head. The tongue 
is thickly coated and the breath very foul; the glands at 



172 DISEASES OF RESPIKATOKY SYSTEM 

the side of the neck may be swollen. On looking into the 
throat one sees enlarged red tonsils with little yellowish 
dots all over them — as a rule both tonsils are affected. 
These little distinct dots may later run together and 
form a patch that an inexperienced person might confuse 
with diphtheria^ but the diphtheritic patch is grayer and 
often more cloudlike. The fever in diphtheria is not apt 
to be so high. It is always wise^ however, to have a culture 
taken if the patient is living in a city where this can be 
done. If there is any diphtheria present it will be found 
under the microscope. 

The acute symptoms do not last long; the patches or 
spots disappear in a few days or a week at the longest^ 
but the swelling and the redness may remain for a few 
days more. 

Treatment. — The child must be kept in bed, and as 
quiet as possible. Calomel must be given at once; the 
proper dose for a child of two or over to take is one- 
quarter of a grain every hour for four or six doses. This 
should be followed by a glassful of citrate of magnesia 
the next morning. Alcohol sponge baths may be given 
for the fever and restlessness. In children too young to 
gargle, a throat spray may be used every two or three 
hours, which may consist of DobelPs solution or borolyptol 
and water — one part to three of water, or Manhattan gar- 
gle tablets in hot water. An older child may gargle 
his throat. 

The food must be liquid while there is any fever — 
milk or broths; then a little later, vanilla ice cream, 
which will greatly soothe the throat, junket, Irish moss, 
blanc mange, and wine or orange jelly are all soothing and 



DISEASES OF THE LAKYNX 173 

easily swallowed by the little patient. After the throat 
has cleared and the child can get up^, some form of iron 
tonic may be given. 

DISEASES OF THE LARYNX 

The larynx or windpipe^ as it is commonly called^ is one 
of the organs of respiration^ which in children is often 
subject to disease. Two of the most frequent disorders 
to which it is subject are catarrhal spasm or catarrhal 
croup, and membranous croup. Let us first consider 
catarrhal or spasmodic croup. 

Catarrhal or Spasmodic Croup 

This is really a catarrhal inflammation of the mucous 
membrane of the larynx, accompanied by spasm. Before 
the child is six months old this trouble is not often met 
with, but from six months up to the third year its oc- 
currence is very common. 

Causes. — Sometimes a child will inherit a tendency to 
croup; in other cases, enlarged tonsils or adenoids may 
be the chief cause. Undue exposure to cold, indigestion, 
or constipation may be the immediate cause of an attack, 
and if a child has once had croup he is more liable to have 
another attack at some future time. 

Symptoms. — While this form of croup usually comes on 
very suddenly in the middle of the night, there are some- 
times signs before the onset which may serve as a warn- 
ing, especially if the child has had an attack previously. 
There may be some hoarseness or discharge from the 



174 DISEASES OF EESPIRATOKT SYSTEM 

nose;, and as the afternoon and evening advance, a hollow, 
barking cough may be noticed. Later in the night the 
breathing will become difficult, the real spasm commence, 
inspiration being especially difficult. The child will waken 
from a sound sleep with all the signs of croup. A mother 
who has once watched one of these attacks is not likely 
to forget it, for the distress of the little patient is great: 
he generally sits up in his crib, struggling for breath. 
His breath comes slowly, the walls of his chest being 
drawn in; his voice is very hoarse and often accompanied 
by the characteristic metallic cough ; his pulse is rapid, and 
he may have a slight amount of fever. In very severe 
cases the lips and tips of the fingers may become blue, 
and the child appear almost exhausted before the trouble 
gradually yields to treatment and the baby falls asleep. 
In some cases one would scarcely know the child had 
been ill the previous night, but most often there is some 
cough remaining and the patient will appear drowsy and 
tired from the loss of sleep. Frequently croup will be 
repeated two or three nights in succession, but after this 
it may not be seen for several weeks or even for the rest 
of the winter, but there are some children who have these 
attacks regularly every few weeks. 

While croup is a most distressing thing to witness, this 
simple form of it rarely if ever proves fatal, and the 
mother should try to keep calm, otherwise the child will 
notice her alarm, and so become worse himself. 

Treatment. — While a doctor should be summoned when 
a child has croup, the mother may do much to relieve the 
baby while she awaits his arrival. In nearly all cases it is 
advisable to make the child vomit, for in that way some 



DISEASES OF THE LAEYNX 



of the mucus can be gotten rid of^ and the breathing made 
easier. About the best thing to use to produce vomiting 
is the syrup of ipecac: this may be given one-half or one- 
quarter teaspoonful at a time^ every fifteen minutes or 
half hour until the child vomits. If for some reason it 
is impossible to obtain ipecac, the child should be made 
to take some tepid water with a pinch of salt or mustard 
in it. 

Every effort should be exerted to relax the spasm of the 
larynx. This may be accomplished by wringing out flan- 
nels in very hot water and wrapping them around the 
child^s throaty the temperature of them as hot as can be 
borne without burning his skin, then changing them 
for fresh ones as soon as they begin to grow cold. Inhaling 
steam is also a most valuable form of treatment, and a 
mother who has a child at all subject to croup will find 
a croup kettle a very precious possession. For method see 
pages 74-77. The steam should be continued until the 
breathing is easier, or the child may be kept in the tent 
made for this purpose by draping sheets over the crib 
twenty minutes at a time, then removed and put back again 
after a few minutes. 

There are several drugs which a doctor may use in 
treating a case of croup, but the mother should not give 
them unless ordered by the physician in charge of the 
child. One safe thing which she may give is a dose of 
castor oil, and if the cliikrs bowels have not recently moved, 
she may give an enema of soapsuds. 

The diet should be restricted to only light food, which 
it has been previously found he can most readily digest. 
He should be kept in the house for several days after 



176 DISEASES OF RESPIKATOEY SYSTEM 

an attack of croup, and not allowed to stand in draughts, 
nor at an open window with his head bare. I have often 
seen children stand at an open window with a door behind 
them wide open, so that there is a tremendous draught 
of air; and then their mothers wonder why it is that the 
child has so many attacks of croup, or such frequent 
colds ! 

Children subject to croup should wear flannels next 
the skin winter and summer, but, of course, of different 
weights. They should have their necks and throats sponged 
with cold water every morning, then briskly but gently 
rubbed, and if there is any trouble with the nose or 
throat, these should be treated by a specialist who under- 
stands his work well. The child should be kept out of 
doors as much as possible on pleasant days, but if very 
damp, or when there are sharp winds, it is better to 
keep him in the house. 

Membranous Laryngitis or Membranous Croup 

Causes, — Membranous laryngitis is almost always due 
to the Klebs-Loffler bacillus but it is just possible that 
another kind of infection may cause it. 

Symptoms, — At the beginning this form of laryngitis 
is not distinguishable from the catarrhal form of croup; 
however, it is not quite so sudden in onset. There is 
hoarseness and cough gradually increasing and difficult 
breathing, which grows rapidly w^orse as the membrane 
spreads. The temperature usually ranges from 99° to 101° 
F. until late in the disease when it may rise to 105° or 
106° F. The loud sawing breathing is the chief symptom. 



DISEASES OF THE LARYNX 177 

the face being pale and drawn and the child in great 
distress. It is difRcnlt to distinguish this from simple 
croup but if there is severe^ constant, and increased diffi- 
culty in breathing with loss of voice, membranous croup 
may be thought of with some degree of certainty. Cul- 
tures from low down in the throat will decide the question. 

Treatment, — The child should be isolated, and full doses 
of diphtheria antitoxin should be given without waiting 
for the culture to be examined. The bowels should be 
opened by calomel, and steam inhalations should be tried ; 
if the child is strong enough ipecac may be given care- 
fully, as for treatment of croup (p. 175). The diet 
should be a fluid one and great care should be taken to 
keep the child quietly in bed until cultures from the 
throat have been negative for some days, as the heart is 
apt to be very weak and may give out if much energy 
is exerted too soon. 

When the breathing is very difficult is may be neces- 
sary for the doctor to insert a little gold tube into the 
larynx or windpipe. 

Acute Catarrhal Laryngitis 

This disease is not so common among young children 
as is the spasmodic form or croup. 

Causes. — "Taking cold'' and exposure to dampness are 
the most frequent causes of this disease. 

Symptoms. — In the mild form there is hoarseness or 
loss of voice and usually a hard dry cough, worse at 
night. The patient is not very ill and has little or no 
fever. In the severe form there is much more temperature 



178 DISEASES OF EESPIEATORY SYSTEM 

usually; it ranges from 100° to 105° F.^ the child being 
much more depressed. There is an almost constant hoarse^ 
dry^ barking cough^ and some difficulty in breathing. The 
attack usually lasts from four to ten days. 

Treatment, — In all cases the child should be put to bed 
at once^ the temperature of the room being kept at 70° 
to 72° F. Calomel or a saline laxative should be given 
and the diet should consist of milk^ broths^, and thin gruels. 
At the beginning of the attack a hot mustard foot bath 
should be given. 

Inhalations of steam are here the most important fea- 
ture in the cure of the child. Simple steam without 
medication may be used^ or sometimes compound tincture 
of benzoin^ or creosote may be added to the boiling water. 
For full directions as to method of giving inhalations see 
pages 74-77. Usually the inhalations are used for fifteen 
minutes every two hours^ but in very severe cases the 
steam may be continued the greater part of the time. 
Small doses of ipecac and squills may be needed^ but if the 
child is sufficiently ill for these he is sufficiently ill to 
have a doctor prescribe them and also administer stim= 
ulants if the pulse requires them. 



DISEASES OF THE BRONCHIAL TUBES AND LUNGS 

Acute Bronchitis 

This is an inflammation of the bronchial tubes and is 
very common in infancy and later childhood. It must be 
promptly treated from the starts, for while not a very 
serious disease in itself^ it may so easily lead to some 



DISEASES OF THE BKONCHIAL TUBES 179 

condition which is more so and the inflammation extend 
downward into the lungs. It is more common in cold 
weather than in warm. 

Causes. — Bronchitis often is seen as a complication of 
one of the contagious diseases, especially measles and 
whooping-cough; in cases of adenoids and chronic catarrh 
an attack of bronchitis is liable to start up at almost any 
time. Eickets also predisposes the child to bronchitis. 
Generally a sudden chilling of the body in connection 
with some germ will start the attack. Children who 
have keen kept in close, hot rooms and overloaded with 
clothing, have had hot baths, and little out-of-door air, 
are very frequent victims. 

Symptoms. — ^The mild form of bronchitis met with in 
infants is observed when the inflammation is only in the 
large bronchial tubes. It generally begins as a common 
cold, followed by a cough, which may be either very severe, 
or may not be so very troublesome. The breathing is 
quicker than normal, and mucus is coughed up into the 
throat and again swallowed, because the baby cannot ex- 
pectorate it. The temperature ranges from 100° to 10'2° 
F. but not often higher ; there may be vomiting and some 
diarrhea, due to mucus swallowed; the child does not 
care for his bottle. A peculiar rattling, wheezing sound 
will be heard in the tubes as the child breathes; this may 
be felt very well when the baby rests against the mother. 
These mild cases last from two or three days to a week. 

The severe cases occur when the inflammation extends 
into the smaller tubes. Here the baby appears very sick : 
his temperature is higher — sometimes 105° or over; his 
breathing is more rapid and very labored, and the cough 



180 DISEASES OF EESPIEATOEY SYSTEM 

may be almost incessant^ and quite "tight/' Often the 
hands and feet as well as the face will appear blue^ and 
very little food will be taken. If the baby is not to get 
well^ he grows rapidly worse^ the cough gradually stops, 
and he is in a sort of stupor, being very blue — he is 
really suffocated by his own secretions of mucus. In the 
average case, however, the baby gets well ; the temperature 
gradually grows less, and the cough also, until at the 
end of a week or ten days the child is well or nearly so. 

Older children have very much the same symptoms as 
infants, but they are not quite so severe, and the dis- 
ease is not considered nearly as serious as in the younger 
cases. 

Treatment, — As one attack of bronchitis makes the 
child more susceptible to another, great care should be 
taken to so build him up that he will not be liable to the 
attacks. 

It is absolutely essential that the child shall have fresh 
air, and plenty of it, and all the sun he can get. His 
nursery must be well ventilated night and day, but it 
is equally important that he should not be allowed to get 
in draughts. He must have a screen around his crib, so 
that the window can be open a little way and still the 
cold air not blow directly on him. If old enough to run 
about or creep, he must not be allowed to sit on the floor 
in cool weather, but must either have an exercise pen 
built on legs, a box with sides to keep off the draught, 
or else sit in a little chair with his toys before him on a 
table when he is not actively running about. He must wear 
flannel next his skin winter and summer — the medium 
weight in winter, and the lightest possible in summer. If 



DISEASES OF THE BRONCHIAL TUBES 181 

he can live in a place where the air is dry and pure, so 
much the better ; his feet must be kept warm at all times. 
The envelope nightdresses which have a long flap in the 
back, which turns up and buttons onto the front of the 
bottom of the nightdress, are the best for young babies 
in winter, and for older children flannel nightdresses with 
feet should be worn. The air in the nursery should never 
be allowed to become overheated — 68° F. is the correct 
temperature for the daytime, and 55° F. at night. Hot 
baths must not be given, but tepid baths, and these should 
be followed by a dash of cold water down the spine and 
a rapid sponge with cold water over chest and neck, and 
later by a brisk rub. 

Older children may stand in a tub of warm water and 
be quickly sponged with cold, and then rubbed briskly, so 
that a healthy reaction is started up. Wet shoes and 
stockings should be at once changed — rubbers worn if the 
pavements are at all damp. Low socks should never be 
used, nor should the child be allowed to go barefoot or 
wear sandals. Easily digested, nourishing food should 
be given. 

For the actual attack of bronchitis the child must be 
put in bed and kept there while there is the least fever. 
If this were more often done the attacks would be easily 
broken up and not be so apt to extend into the smaller 
tubes. At the beginning of the attack either castor oil 
or calomel should be given — from one teaspoonful to one 
tablespoonful of the oil, according to the age of the child : 
or one grain to one and one-half of calomel is divided into 
doses of one-tenth grain every hour for babies, or one- 
fourth grain for older children. 
13 



182 DISEASES OF EESPIRATOKY SYSTEM 

The next thing to be done is to apply a mustard paste 
to the entire chesty back, and front. One tablespoonful of 
mustard and five of flour should be mixed well together 
with a little cold water, like a cake batter, and spread on 
old, thin linen or cheesecloth ; then another layer put over 
it, and the ends neatly folded so as to prevent leaking. 
This may be warmed a little by holding it near the fire, 
and then wrapped about the child's chest. Care should 
be taken to pull it up back and front, so that it will reach 
up to the neck. A clean towel may be folded over it so 
it will not soil the nightdress or blanket which covers 
the child. The paste must be left on long enough to 
well redden the skin — from five to ten minutes usually ac- 
complishes this end, but children differ much in this respect 
and the skin must be looked at from time to time. At 
the end of this time the paste must be removed and the 
chest quickly rubbed with warm olive oil, then the night- 
dress put on. The paste must be thrown away and a 
fresh one made every time; one paste has been known 
to break up an attack if it was put on early enough; 
however, it may be necessary to repeat these pastes every 
three or four hours, according to the child's condition. 

Inhalations of steam may also be used in treating 
bronchitis in early childhood. It should be given as al- 
ready described on pages 74-77. Simple water vapor is at 
first best, but after the first two or three days pine-needle 
oil, compound tincture of benzoin, or creosote may be used; 
a few drops of any one on the sponge of the inhaler or in 
the water of the kettle, may be of benefit. It should 
be given for fifteen minutes every three or four hours, in 
a tent, or, for mild cases, may simply be kept burning in 



DISEASES OF THE BEONCHIAL TUBES 183 

the room the greater part of the time. This will relieve 
the irritating cough better than any other remedy. 

If the child becomes very much choked up and cannot 
get rid of the excess of mucus^ ipecac may be giveU;, as 
for croup^ until he vomits, but this should only be done 
when very necessary. Little tablets of antimony and 
ipecac — one one-hundredth of a grain each — given every 
two or three hours^ will help to loosen the tight cough. As 
soon as it becomes looser^ then Brown Mixture — ten drops 
for a young infant^, or one-half teaspoonful for a child 
of one year or over — may be given every three hours; or 
else one teaspoonful of Hive Syrup, one of sweet spirits 
of nitre and one of paregoric, with enough water to make 
three ounces, may be given every three hours — one tea- 
spoonful to older children, and a half teaspoonful to babies 
under one year of age. If the child is taking little food 
and seems weak, liquid peptonoids, given in one-half to 
one teaspoonful doses in a little water, may be helpful; 
and in extreme cases, a few drops of whiskey or brandy, 
as stimulants, may be needed at especially bad times. The 
high fever must be controlled by alcohol sponge baths or 
an icecap, and not by drugs, unless especially needed for 
an individual case and prescribed by a doctor. The cough 
may hang on for some time after the child is well ; in other 
respects, and in such cases, liquid peptonoids with creosote 
is very helpful, but it must not be given near mealtime, as 
it may upset the child's stomach. 

Drugs should be used as little as possible; external ap- 
plications and pure food and air should be relied upon 
to build up the child and also in treating the attack. 

The food must be diluted about one-half at first, for a 



184 DISEASES OF KESPIKATOET SYSTEM 

bottle-fed baby, and gradually strengthened, and a breast- 
fed baby may be given an ounce of water or barley water 
before each meal, then kept at the breasts a little shorter 
time than usual, until he is better. An older child should 
have only a fluid diet when there is any fever. 

Bronchial Asthma 

This disease is distressing at all times, but especially 
so in children. It is a disease of the nerves and often is 
seen in the children whose parents or grandparents have 
been very neurotic, or those who have had gout. 

Hay-fever and rose cold are forms of asthma. Children 
with adenoids, enlarged tonsils, or any irritation of the 
nose and throat are frequent victims of asthma. 

Causes, — Anything which irritates the mucous mem- 
branes of the respiratory tract may be a local cause. 

Being out on a damp day, a sudden change of weather, 
driving in the wind, or certain odors are likely to bring 
on another attack at almost any time. In summer the 
attacks are less severe and less frequent. In hay-fever 
and rose cold forms, the chief symptoms are the great 
catarrhal secretions from the nose and "stopped up'^ feeling 
in nose and head. If the cases can be taken to a suitable 
climate, they many times completely recover, but if they 
must remain in a damp, changeable place, the attacks are 
likely to continue until perhaps a child outgrows them, or 
they may last throughout life. 

Symptoms, — ^An attack of asthma in a child closely 
resembles that in an adult. There is great difficulty in 
breathing; the chest is seen to heave, and the child may 



DISEASES OF THE BEONCHIAL TUBES 185 

become blue from his efforts to breathe. Wheezing and 
rattling sounds may be heard in the chesty and the distress 
of the child is pitiful to see; there is more or less cough, 
but it is not usually severe. The attack may last a few 
hours or several weeks^ the symptoms not being equally 
severe at all times, and gradually wearing off. 

Treatment. — Every child who has any form of asthma 
should be taken to a nose and throat specialist, and have 
a careful examination of these organs made. If anything 
abnormal is found it must be righted before anything can 
be hoped for in other ways. For the attack itself the 
bowels should at once be opened by castor oil or calomel. 
Inhalations of steam as for bronchitis, and the application 
of the mustard paste that covers the entire chest, will 
often help to shorten an attack. Fumes from burning 
nitrate of potash will also help some cases. For medicine 
internally it may be necessary to give a little ipecac, as for 
croup, because after vomiting the patient is often relieved. 
Bromid of soda, antipyrin, and several other drugs are at 
times beneficial, but they must be given by a doctor who 
can watch their effects upon the child in each individual 
case. 

The reduction of sugar in the food and the addition of 
bicarbonate of soda to the milk, may be safely given by 
the mother. Babies who are being fed from the bottle 
must have the sugar reduced one-half, or entirely omitted. 
Saccharin may be used instead; one grain for the day's 
food supply. Older children should be taught to do with- 
out sugar on their cereals, and have no candy or other 
sweets. One grain of bicarbonate of soda for each ounce 
of milk the child takes may be given. Little meat, espe- 



186 DISEASES OF EESPIEATOEY SYSTEM 

cially red meat, and plenty of fresh, green vegetables/ are 
desirable in feeding older children, especially if of rheu- 
matic families. The bowels mnst be kept open. 

Bronchopneumonia 

Caitses. — Bronchopneumonia is the variety of pneumonia 
most often seen in babies under two years of age and in 
children who have recently had an infectious disease. It 
is always a grave disease, but when properly handled much 
may be done to save the little patient. It is much more 
prevalent during the cold weather than during warm, but 
may occur at any time. Children who have measles, 
whooping-cough, or influenza are very apt to develop 
bronchopneumonia. Exposure to cold and the extension 
of the inflammatory processes of catarrh and bronchitis are 
many times responsible for cases of bronchopneumonia. 
Children kept in close, badly ventilated rooms are also 
frequent victims of pneumonia. 

Symptoms, — Cases which accompany or follow other 
diseases begin with the symptoms of these diseases, but 
in cases which occur by themselves the symptoms are often 
Tery sudden, the fever, cough, and difficult breathing being 
the first symptoms noticed by the mother, who will not be 
able to distinguish it from bronchitis at first. Sometimes 
an attack of vomiting will usher in the disease, and more 
rarely a convulsion. At first the bowels may be consti- 
pated, but later there is usually diarrhea and mucus passes 
with the movements. 

The general symptoms in all varieties of the disease are 
at first a hot, flushed face which may later become pale 



DISEASES OF THE LUXGS 187 

and often rather blne^ especially about the mouth and 
finger tips. The skin will be hot and dry^, the child rest- 
less and irritable^ often refusing food rather than take 
the trouble to nurse either by breast or bottle, as he needs 
every moment to breathe. There is often quite a profuse 
nasal discharge of mucus; at times also the eyes may 
become reddened and contain some pus. 

Here the cough is much more noticeable than in the 
other forms of pneumonia — it is a dry, hacking, and dis- 
tressing cough that worries the child, and sometimes makes 
sleep almost impossible. Young children cannot, of course, 
expectorate, but they bring up the mucus only to swallow 
it again, or many times vomit it with or without their food ; 
a severe cough will often make the child vomit. The 
difficult breathing may be a very distressing symptom, the 
child being quite blue from its struggles to breathe, and 
there may be a little grunt at almost every breath. The 
nostrils work noticeably and the pulse is rapid at times. 
The temperature varies much — is as a rule much higher 
in the evening than in the morning, but it is not quite as 
high as in the other form of pneumonia. It runs from 
98^ in the morning to 103° or 104° in the evening. It 
is very irregular as a rule, and one never knows when to 
expect a rise or fall; generally the temperature drops 
gradually as the child becomes better. 

Days or weeks may be the course — there is no set limit 
for a case of bronchopneumonia. A highly strung or 
spoilt child will exhibit at times some nervous symptoms, 
but these are not apt to be seen as much as in the other 
kind of pneumonia. The diarrhea may be quite a grave 
symptom, and need treatment as in other cases of the 



188 DISEASES OE EESPIEATOEY SYSTEM 

same trouble. By making a daily examination of the 
baby's chest the doctor will be able to tell how the disease 
is progressing. 

Complications, — Earache^ with sometimes a resulting 
abscess in the ear, is a very frequent complication of 
bronchopneumonia^ and when the baby evidences great 
pain or the temperature suddenly becomes much higher, 
this should be thought of and the ear examined. 

It should be treated as in any other case of earache, or 
if the drum is very red and bulging the doctor will make 
a little cut in the membrane, and the pain will cease. 
Empyema, or abscess in the pleural cavity, may occur, but 
it is not so frequently seen as in the other form of pneu- 
monia. 

To distinguish bronchopneumonia from bronchitis must 
be the work of a skilled physician. In cases of pneumonia 
the child usually appears sicker and the fever lasts 
longer than in bronchitis. The chest signs that the doctor 
hears will usually distinguish it from lobar pneumonia — 
the other kind seen in childhood. Also the irregular fever, 
being sometimes high, again low, is quite different from 
the other form in which the fever is usually high and 
remains high, until the crisis, rarely if ever getting below 
100° F. 

Treatment. — Castor oil or calomel must be given at the 
start, as in most cases where there is fever. Mustard 
paste and inhalations of steam must be given as in cases 
of bronchitis (page 182). The fever must be reduced by 
alcohol sponge baths if the child is restless, but if quiet 
and asleep it is best not to disturb him except when really 
necessary. It is a good plan to take the temperature, give 



DISEASES OF THE LUNGS 1S9 

the sponge bath, apply the mustard paste, and give the 
inhalation of steam near a mealtime, then after the child 
is fed he will be able to have a long, nninterrnpted sleep 
without being constantly disturbed. The general care, 
ventilation, etc., of the sickroom should be the same as 
that described in the treatment of bronchitis. If the 
abdomen becomes distended a rubber catheter must be 
inserted into the rectum, or the bowels irrigated to get 
rid of the gas, as the intestines when full of gas press 
upon the heart and lungs and make it more difficult for 
the baby to breathe. If there is very labored breathing 
or blueness, oxygen may be needed. The child's position 
must be often changed from side to side, and in many 
cases if the baby is vrrapped up it will be a great help 
to hold him over one's shoulder for a few minutes at a 
time every day. 

His food must be easily digested, and diluted if a bottle- 
fed or breast-fed baby; it is usually well to peptonize the 
milk for a while at least in the case of a bottle-fed baby. 
Older children must have milk and broths as their diet. 
Liquid peptonoids are here also advisable, and if the pulse 
is weak the doctor will advise stimulants as he judges they 
are indicated. The child's stomach should be saved as 
much as possible, and he should not be given drugs when 
it can be avoided. When the baby is convalescent a tonic 
of iron, or liquid peptonoids and creosote or cod-liver 
oil in cold weather, may help him to grow strong 
quickly. 

If he can be taken to a dry, moderately warm climate 
for a short time, his return to health will be much 
quicker. After the lungs have cleared up and the fever 



190 DISEASES OF KESPIEATORY SYSTEM 

drops, if this cannot be done, he should be aired in the sun, 
indoors at first ; then later go out every day. 

Lobar Pneumonia 

This form of pneumonia is sometimes called croupous 
pneumonia^ or pneumonic fever. It is really an infectious 
disease caused by a germ, and runs a regular course. It 
is the kind of pneumonia we most often see in adults, but 
it may occur at any age; in children it is perhaps the 
most frequent from the second to the sixth year. Many 
cases occur in winter, but in the spring the disease is 
more prevalent than at any other season. 

Causes, — Children who are robust are as likely to have 
this variety of pneumonia as those who are delicate; they 
must in some way become infected with the pneumonia 
germ, and then perhaps a cold or sudden chilling of the 
body may help to bring on the attack. The melting snow 
and high winds of March are responsible for many cases, 
as the germs found in street filth are readily carried about 
by the wind. Either one or both lungs may be affected, 
but it is a little more common in the right lung than in 
the left. 

Symptoms. — The onset of this kind of pneumonia is 
sudden ; many times it begins with an attack of vomiting, 
and sometimes it may be ushered in by a convulsion. If 
the child is old enough to talk he may complain of a 
headache or pain in his side, or refer to the pain in his 
abdomen. I once knew a prominent physician who thought 
a child might be going to have appendicitis because he 
referred the pain to the region of his appendix, but after 



DISEASES OF THE LUNGS 191 

a few hours the regular signs of pneumonia were found. 
Eapid breathing is noticed very early, and the nostrils may 
soon become active, while the characteristic little grunt 
is heard. Here the cough is not at all a marked symptom, 
and may be even absent or so slight as not to be noticed. 
When it does occur it is apt to be dry and hacking and 
may cause pain. Later in the disease it is more apt to be 
present than in the early stage. There is practically no 
expectoration in children. The bowels are many times 
constipated; in the case of young babies there may be 
diarrhea, but this is not as often looked for as in broncho- 
pneumonia. The skin is dry and hot, the cheeks flushed, 
the tongue much furred, and there may be feversores on 
the lips. The urine is usually scanty and high colored; 
the pulse is rapid and full at first, but later it may become 
weaker. 

The temperature is one of the most characteristic symp- 
toms; it goes up with a jump and is very high almost from 
the first. It generally reaches 104° F. or 105° F. on the 
first day, and stays nearly as high as this, or even higher, 
until the crisis of the disease, when it takes a sudden 
drop to nearly normal or may even go below normal. Many 
times after the first drop the temperature will stay below 
normal for a day or two and then rise to the normal 
point. There is a distinct crisis in about one-half of all 
the cases occurring in childhood; this most often occurs 
from the fifth to the eighth day, but may be sooner or 
later — we generally look for it on the seventh or eighth 
day. The temperature which has been steadily high for 
a week or so then suddenly drops, and whoii this occurs 
the child is much more comfortable : he breathes easier, but 



192 DISEASES OE EESPIRATORY SYSTEM 

may be exceedingly weak. There is often delirium in 
cases of lobar pneumonia, especially when the temperature 
is very high at the height of the disease, and there may 
be twitching and other nervous symptoms; there may also 
be convulsions here as well as at the onset of the disease. 

Complications. — Abscess of the ear is one of the most 
frequent complications. It may occur at any time of the 
disease, but if the temperature does not drop as it is ex- 
pected to, or if it has gone down and suddenly runs up 
again, this is one of the first causes of the disturbance to 
be thought of. Pleurisy, either dry or with fluid, some- 
times complicates pneumonia. 

Sometimes the temperature will be kept up by an exten- 
sion of the pneumonia either to another part of the same 
lung, or to the other lung; under these conditions the 
disease is prolonged indefinitely and the case is much 
more serious. 

Treatment, — In an uncomplicated case of lobar pneu- 
monia we naturally expect the patient to recover, especially 
if he is a child over two years of age. It is nevertheless 
a serious disease and one that needs careful nursing and 
doctoring with good judgment on the part of the mother 
or nurse. 

We must take into consideration that this sort of pneu- 
monia is a self -limited disease and will very likely run its 
own course no matter what we do; therefore, it is a great 
mistake to give numerous drugs in the hope of breaking 
it up. The child must be carefully watched and the treat- 
ment given him that will make him most comfortable. 
The open-air treatment has many advocates: the child is 
well wrapped and has hood and mittens on; hot water 



DISEASES OF THE LUNGS 193 

bags are placed in his crib at his feet^ and light but warm 
coverings are put on him; then he is taken to a roof or 
a porch where he remains most of the time. Many suc- 
cessful cases have been carried through by this method. 
Others advocate fresh air in a large^ well-ventilated room. 
This plan is more apt to meet with the ideas of the mother 
and accord with conditions in more households. Even 
in the middle of winter the windows may be lowered, a 
screen protecting the child from direct draughts. With 
his high fever he will be much more comfortable in a room 
full of fresh air^ and where he can breathe easier and 
will not take cold. His hands and feet must be kept 
warm by means of mittens, woolen stockings, and hot 
water bags. Care must be taken to keep the child's mouth 
clean. It should be washed several times daily with boro- 
lyptol and water, or boric acid solution. 

His diet from the start must be liquid, milk or broths, 
given every three hours, and in the interval plenty of 
cool water should be given him to drink. If a young 
baby, the food must be diluted about one-half its usual 
strength, and peptonized if the least signs of indigestion 
are seen. 

The bowels must be kept open daily. At first it will 
be well to give calomel — about one grain — in divided doses, 
as for bronchopneumonia ; if a later laxative is needed, the 
milk or the citrate of magnesia may be used. For any dis- 
tension of the abdomen from gas in the bowels the catheter 
must be inserted; often injections of salt solution are 
used, or an enema given. 

At least twice a day the entire body should be sponged 
with lukewarm water and alcohol, but this should be care- 



194 DISEASES OF EESPIEATOEY SYSTEM 

fully done^ the child being disturbed as little as possible. 
Tor a fever over 103° F. extra sponge baths may be given^ 
and an icecap kept on the head for an hour or so at a 
time; when the temperature is 105° or over^ an ice pack is 
helpful, especially if the child is restless. Dr. Holt once 
remarked, "The child, and not the thermometer, must be 
treated.^^ It is foolish to awaken a child from a calm 
and comfortable sleep to give a pack. Just because the 
thermometer registers 104° or 105° F., but if that child 
is uncomfortable from his high fever, something should 
be done to reduce it. 

The best way to give a child an ice pack is to place a 
rubber sheet on the bed, then a pad on that; a very large 
towel or a crib sheet should next be placed in lukewarm 
water wrung out and wrapped about the naked child, fold- 
ing a part of it around each arm and leg; a piece of ice 
about as large as one^s fist should then be gently ironed 
over the entire body, covering the places under the arms, 
and in the groins especially. An icecap should be at the 
head while this is being done, and if the feet are at all 
cold, a hot water bag should be placed there. This may 
be kept up for ten or fifteen minutes if the child does not 
become blue; if he does, he should at once be removed 
from the pack, and heat applied while he is rubbed with 
a warm hand, and a little stimulant given. This blue ap- 
pearance rarely takes place, however. After the ice rub- 
bing the child may be left in the wet sheet for an hour 
or so, then the temperature taken, and if it has dropped 
a little, or if the child seems i^ore comfortable, the wet 
sheet may be removed and the nightdress slipped on with 
a light covering over it. The icecap may remain in place. 



DISEASES OF THE LUNGS 195 

If the child is still restless and has a high fever, the 
ironing with ice may be repeated. Other physicians like 
to keep cool compresses on the child^s chest the greater 
part of the time, but I have not found this to be very 
well borne by the average child. Alcohol sponging, and 
a pack, when necessary, I have found more effectual, and 
better borne by the little patient. 

All these methods of reducing the fever and making 
the child comfortable are much better than giving drugs. 
If the cough is troublesome, inhalations of steam, as al- 
ready described, may be tried, and if there is much pleurisy 
or the child complains of pain, the mustard paste may 
be used. When the child is taking little food and a mild 
stimulant is advisable, liquid peptonoids may be given. 
If the pulse is weak, especially during the small hours of 
the morning, whiskey diluted six or eight times with 
water may be needed. Diluted in this way, one-half or 
one ounce in twenty-four hours may be given according 
to the judgment of the doctor in charge. It is much better 
to hold off the stimulants until just before or about the 
time the crisis is expected; they may then be given for 
a few days to help the tired heart and lungs back to 
health. For a blue color nitroglycerin is a medicine 
much used. Strychnin is also given when the whiskey 
alone does not prove enough, but these drugs must be 
ordered by the doctor in charge for each individual case. 
After the temperature has dropped and has remained down 
for a day, an eggnog, wine jelly, milk toast, blane mange, 
etc., may be gradually given to children of more ad- 
vanced age. Orange juice may be taken throughout the 
disease and may help to keep the bowels open and relieve 



196 DISEASES OF EESPIEATOKY SYSTEM 

the thirst. An iron tonic or cod-liver oil may be given 
for a while to help build up the child after the disease. 
Oxygen may be needed if the child breathes with great 
difficulty or his color becomes bad. 



CHAPTEE VIII 

DISEASES OF THE NERVOUS SYSTEM 

The nervous system of infants and children is such an 
exceedingly delicate one that very little is needed to up- 
set it. Babies and children are very sensitive to nervous- 
ness in any grown person about them: a nervous mother 
or nurse who is taking care of a baby may nearly always 
expect to see some nervous manifestation in her charge. 
Especially is this true of nursing infants. The child 
feels the high^ nervous tension which surrounds it much 
more quickly than an adult would, and suffers in propor- 
tion. Nervous disorders in childhood are often very ob- 
scure and extremely difficult to diagnose and treat; hence 
it will be possible to describe only the most common dis- 
eases of the nervous system here. 

Convulsions 

Owing to the extremely delicate nervous organization 
of infancy and early childhood, convulsions are much more 
liable to take place than in later life. 

Causes. — The inheritance of a nervous temperament 

makes a child much more subject to convulsions than he 

otherwise would be. Many of the infectious diseases are 

ushered in with a convulsion. The most frequent cause 

14 197 



198 DISEASES OF THE NEKVOUS SYSTEM 

of all^ however^, is some irritation from the stomach or 
bowels^ so that when a child is seized with a convulsion, 
and until some other definite cause is discovered, it is 
best to consider this as the cause. Intestinal parasites, 
phimosis (or tight foreskin) with collection of smegma 
under the foreskin, adenoids, and any disease in which 
there is a high temperature, may also cause a convulsion. 
Besides the above there is a large class of convulsions 
caused by direct irritation of the brain or some of its 
membranes. A clot of blood or hemorrhage, which often 
takes place at birth, meningitis, tumors of the brain, or 
abscesses, extension of infective matter from the ear into 
the brain, blows or injuries of the head, and epilepsy, are 
all well-known causes of convulsions. 

Symptoms, — As a rule convulsions come on very sud- 
denly, but there is sometimes a slight warning, such as 
restlessness, twitchings of the extremities, or eyelids. The 
face becomes pale, or, later, blue, the eyes fixed, or rolled 
upward, and general twitchings occur, or else only a part 
of the body may be affected. Contortions of the face are 
usually marked, and the other convulsive movements may 
be violent or only slight. Again they may last only a 
second, or for some minutes. There is often frothing at 
the mouth, irregular, shallow breathing, irregular pulse 
and loss of consciousness. There is generally considerable 
weakness after the active convulsion is over, and the child 
may fall into a heavy sleep. There may be but one attack 
of convulsions, or there may be several; this depends to 
a great extent upon the cause. There may be paralysis of 
one or more of the extremities, loss of speech, or a dis- 
torted face. Children who have convulsions many times 



CONVULSIONS 199 



recover with apparently no bad effects; here again it all 
depends upon the underlying cause. Convulsions due to 
indigestion^ worms^ phimosis^ rickets^ dentition, or some 
reflex condition, terminate much less frequently in death ; 
but those due to direct irritation of the brain are more 
apt to be fatal or leave some lasting paralysis. One attack 
of convulsions always makes a child more susceptible to 
others or indicates an unstable nervous system. 

Treatment. — It usually takes a skilled physician to di«- 
cover the cause of a convulsion and then prescribe the 
treatment that will prevent further attacks. For the con- 
vulsive attack itself the child should be quickly undressed 
and placed in bed in a quiet room. Cloths wrung out of 
ice-water should be placed at his head, and his feet and 
legs put in mustard water — one tablespoonful of mustard 
to a gallon of water — temperature 105° F. being used, in 
a deep vessel of some kind. The body and arms should 
be wrapped in a large towel or small sheet, wrung out of 
the mustard water, and this should be left on the child 
until his body is quite red. If one can quickly procure an 
icebag, it should be left on the head for at least an 
hour after the convulsion is over ; if not, the ice cloths may 
be frequently changed to keep them very cold. In place 
of this mustard pack some prefer a hot mustard bath, 
but I have found that the pack disturbs the child less and 
is quite as effectual. 

A high enema of warm water and soapsuds should be 
given as soon as possible — from one-half to one pint is 
usually enough to give. Many times, as soon as the bowels 
are cleared, the convulsions will at once cease. As soon as 
the child can swallow he should be given a dose of castor 



200 DISEASES OF THE NEEVOUS SYSTEM 

oil — one teaspoonful to one tablespoonful, according to the 
age of the child; or 

Schedule for Dose of Calomel 

Age Amount Time 

Under 1 year Vio grain every hour, for 10 doses 

Over 1 year Vs grain every hour, for 8 doses 

In convulsions that are very severe, and often repeated, 
inhalations of chloroform are sometimes the only means 
of quieting a child, but a doctor or nurse must administer 
this — never a mother. Bromid and chloral, one or both, 
are sometimes needed in convulsions often repeated or of 
long duration; here again the doctor must prescribe for 
each individual case, as these drugs are very dangerous 
and must be used by a skillful person only. 

Convulsions that depend upon a local cause, like tight 
foreskin or adenoids, can be prevented by removing the 
cause. Circumcision should be performed, or else the 
adenoids taken out, as the case may be. 

A child who has had a convulsion should be kept on 
broths or gruels for at least twenty-four hours, then given 
diluted milk or whey, and very gradually return to solid 
food of an easily digestible nature. He must lead a quiet, 
open-air life, free from all excitement, and have plenty 
of sleep. 

Chorea 

{8t, Vitus' s Dance) 

This is a functional nervous disease in which there are 
spasmodic movements of one or more groups of muscles. 
There is also generally a mental irritability. 



CHOEEA 201 

Between the ages of seven and fourteen years chorea 
is most common^ although younger children may have it; 
females are more apt to have it than are males, and it 
is more frequently seen in the spring months than at 
other times. 

Causes. — The relation of chorea and rheumatism is very 
marked in many cases. Eheumatism may occur before 
chorea^ with it, or after it in a large percentage of the 
cases. Chorea may be caused by overwork at school, 
adenoids, enlarged tonsils, adherent foreskin, or it may 
occur as a sequel to the infectious diseases. 

Symptoms. — In chorea the onset is usually gradual, the 
child growing more and more nervous and irritable until 
the regular spasmodic movements set in. A child at 
school will have difficulty in writing, and will be clumsy 
and is apt to drop things all the time. In some cases 
the trouble starts in the muscles of the face; in others 
in the legs, as the child will be noticed to stumble as he 
goes up stairs. The peculiar, jerky movements of chorea 
can seldom be mistaken for anything else, even by a casual 
observer. 

Treatment. — It is generally best to take the child out 
of school. He must never be allowed to get tired and must 
be made to lie down at least two hours in the middle of 
the day. If he is a city child a visit to the country will 
often help very much; and if his mother is excessively 
nervous he should be placed in the charge of other persons 
for a time at least. A mother should not attempt to use 
the drugs employed for chorea. Each individual case 
should be studied by the doctor, and the medicine should 
be prescribed by him. Salicylate of soda, arsenic — Fowler's 



202 DISEASES OF THE NEKVOUS SYSTEM 

solution — and iron are the drugs most frequently given 
in the treatment of this disease. It is best to have the 
eyes examined when a child has chorea, for defects there 
often aggravate or even cause the disease. 

It must be borne in mind that chorea has a tendency 
to return, and a child who has once had it must be care- 
fully watched and never overtaxed in his studies. 

Habit Spasms 

Sometimes without warning a child will suddenly de- 
velop peculiar spasmodic movements of the face or other 
parts, but it will be limited to one group of muscles. 
Blinking the eyes quickly, making peculiar grimaces, jerk- 
ing of the hands or legs, are among the many frequent 
varieties seen. Every effort should be made to discourage 
these habits as soon as formed. If the child is at all run 
down, iron or cod-liver oil may be tried at home, or the 
doctor should be asked to prescribe a regular- nerve tonic, 
such as strychnin. 

Hiccough 

This may be regarded as a spasm of the diaphragm and 
is often seen in infants and young children. 

Causes, — Overeating, taking the food too rapidly, gas on 
the stomach, sudden chilling of the body, are all frequent 
causes. 

Treatment, — The following are all useful measures in 
stopping the hiccough: giving hot water, either plain or 
with a soda mint tablet dissolved in it; putting a very 
little sugar on the tongue; holding the child over the 
shoulder and gently patting his back. 



NERVOUS HEADACHE 203 

Nervous Headache 

Causes, — Children often complain of headache simply 
because they have heard an older member of the family 
do so; but the complaint should not be dismissed lightly 
without investigation of some kind. Many times it is due 
to eye strain and the child who frequently complains of 
this pain should be taken to an oculist to have his eyes 
tested. Children who are constipated or have some form 
of intestinal or gastric indigestion^ often suffer from head- 
ache; this should be thought of, and the stools and urine 
watched. If a specimen of urine is tested it will often 
show evidences of intestinal indigestion, and the trouble 
can then be righted. Many of the infectious diseases be- 
gin with a headache: meningitis nearly always sets in 
with this symptom. Fatigue, overwork at school, malaria, 
and excitement in nervous children, many times cause 
headache. 

Treatment. — The treatment depends upon the cause of 
the headache. It is a good plan to give a cathartic in 
nearly all cases and to keep the child as quiet as possible, 
making him lie down for a time and take a nap if possible. 
Icebags or ice cloths placed at the head often give con- 
siderable relief. Sweets should be forbidden, and a light, 
easily digested diet allowed. Headache cures should not 
be given to a child; fresh air and change of climate, if 
the attacks are frequent, will often break them up. 

Nervous Disorders of Speech 

Stammering and stuttering are not infrequently met 
with amon^ children. 



204 DISEASES OF THE NERVOUS SYSTEM 

Causes. — Many times the trouble is inherited; at others 
it takes place after a long illness or when the child is 
run down and anemic; again it may be the result of 
imitation. 

Treatment, — Tonics should be tried and the child sent 
into the country if possible^ or made to live out of doors 
as much as possible. He should be taught to take very 
deep breaths between his words^ and receive instruction 
from a teacher in articulation and deep breathing, if one 
can be obtained. The child should be given the best 
hygienic attention possible, and if he can stand it, a 
rapid, cold sponge bath followed by a brisk rub should 
be given every day. The food must be regulated to exactly 
suit the child^s digestion, and if the weather is cool enough 
and the stomach can bear it, cod-liver oil may be given. 

Sleeplessness or Disturbed Sleep 

This is a very common disorder of early life, and is due 
to a great many causes. 

Causes, — Improper feeding of some sort is the most 
usual cause in infancy; another very frequent cause is 
poor training of the child. He is allowed to turn night 
into day just because he happens to want to; he may 
take a fancy for being walked with or rocked at any time 
of the night, and as he finds he can have what he wants 
by crying for it, he will try it night after night. Pain from 
coming teeth, colic, or earache also cause restless sleep, 
but walking with or rocking the child does not quiet him 
when he is suffering from real pain. In older children 
intestinal indigestion, suppers that are too heavy, adenoids. 



DISTUKBED SLEEP 205 

enlarged tonsils, asthma, violent play before bedtime, over- 
work at school, worry about examinations, fright instilled 
by foolish nurses, are the most frequent causes. 

Treatment, — ^The cause must be hunted for and found 
before the treatment can be begun. Any indigestion must 
be treated by a change in food, as already described under 
indigestion {^see pp. 127-130). Never, under any circum- 
stances, should the child be given soothing syrups; it is 
criminal to do this. If the teeth are the cause of pain, 
the gums may be lanced or the tooth rubbed through, if 
possible. If there is an earache, dry heat should be tried 
and a doctor asked to examine the drum. A warm bath 
may be given at bedtime and all the clothing changed ; the 
room should be well aired, and all lights should be turned 
out. A bottle or drink of water, either hot or cold, may 
be given, but no extra night feeding, as this only makes 
matters worse; this is especially true of breast-fed babies 
who have been allowed to nurse most of the night. A 
little discipline is many times the best sort of treatment. 

Night Terrors of Childhood 

Children often have screaming attacks at night, waking 
from a sound sleep apparently much alarmed and fright- 
ened. When this occurs it can generally be traced to one 
of the following causes: adenoids or enlarged tonsils, the 
need of being circumcised, a heavy supper, excess of play 
or excitement near bedtime. The mother should take all 
these causes into consideration and if she cannot deter- 
mine which is the cause of her child's trouble, she should 
have a complete examination made by her family physician. 



206 DISEASES OF THE NEEYOUS SYSTEM 

BAD HABITS OF CHILDHOOD 
Thumb-sucking Habit 

Thumb-sucking and sucking a pacifier, or sugar rag^ 
is exceedingly common in babies and young children. It 
is one of the worst habits a baby can form. The con- 
stant suction wastes the saliva that is meant to digest the 
food and thus causes indigestion. Germs get on the thumb 
or pacifier and often cause sore mouth. This is especially 
true of the pacifier which is dropped on the floor or may 
be left lying about for flies to crawl over and then is 
placed in the baby's mouth, causing infection. The con- 
stant suction also causes enlarged tonsils and adenoid 
growths. It ruins the shape of the mouth and often makes 
the coming teeth protrude. 





Fig. 18.— "Hand-I-Hold" Mnrs. (Courtesy of R. M. Clark & 
Co., Boston, Mass.) 

Treatment. — The moment it is found that a baby has 
this bad sucking habit, means must at once be taken ta 
stop it. Cotton bags or mittens on the hands should be 



BAD HABITS OF CHILDHOOD 207 

tried, or it is often a good plan to take a piece of stiff 
paper or cardboard and fold it around the arm outside 
of the shirt but inside of the dress so that the elbow 
cannot be bent to get the hand to the mouth, but which 
at the same time will allow the baby to handle toys. If 
this is done the paper or splint must be taken off twice 
daily and the arm bent and left free for a little while so 
it will not become stiff. Celluloid and aluminum mitts 
may also be had in some places to stop this thumb-sucking 
habit. A baby over one year of age may be broken some- 
times by having bitter aloes or a solution of quinin put 
on the thumb. At any rate, the habit must be broken. 
If the pacifier is the article sucked, it should simply be 
burnt and never replaced. 

Nail-biting Habit 

The same means may be taken to break up the nail- 
biting habit. 

Tongue-sucking Habit 

If the tongue is sucked, not very much can be done. 
A good plan is to put a little vinegar or lemon juice on 
the tongue every time it is sucked, or sometimes a drop 
of aloes or quinin will answer. Usually this habit is of 
short duration and the child will outgrow it of his own 
accord. 

Perverted Appetite or Dirt-e-\ting Habit 

Symptoms, — This habit is shown by the child in a desire 
to eat dirt, sand, wall plaster, coal, etc. 



208 DISEASES OE THE NEKYOUS SYSTEM 

Causes, — It is a sign of a nervous, highly strung tem- 
perament in many cases while in some cases the child is 
mentally defective. 

Treatment, — The diet should be a most nourishing one 
and at the same time one that is easily digested. A 
tonic should be given if the child is anemic. Constant 
watching is needed. If the child is still very young he 
should be kept in his carriage or in a baby-yard whenever 
the mother cannot be with him. 



Masturbation 
Self-ahuse 

This is one of the most serious and annoying diseases 
of childhood. It is practiced even by infants of both sexes 
as young as eight months. 

Causes. — Local causes should always be looked for. In 
boys the foreskin may be difficult to push back, adhesions 
being present. In girls the part called the clitoris may 
be the source of the difficulty — adhesions being found here. 
Urine that is too acid, pinworms, eczema, or any other 
skin irritation of the parts, may be the exciting cause. 
Again no special cause can be found. The child may be 
highly strung and inherit nervous tendencies which show 
themselves in this way. Older children often learn this 
bad habit from one another or from vicious nurses. 

Symptoms. — The habit may be manifested in many dif- 
ferent ways. The hands may be used to rub the parts; 
the thighs may be rubbed together while the legs are 
crossed; the child may rub himself on some object, as a 



BAD HABITS OF CHILDHOOD 209 

chair or the floor, or it may be shown in endless other 
ways which are not recognized at first. 

The parts may look red and swollen, or, in some cases, 
there may not be anything to see. The child^s face may 
flush or a perspiration may break out while masturbation 
is being practiced ; great excitement followed by relaxation 
is usually seen. The habit may be indulged in at any time, 
but the favorite time is at bedtime or when awaking early 
in the morning, as the child is more apt to be alone at 
these times. As the habit grows the child will usually lose 
all sense of shame and will indulge in it at any time or 
place — all self-control is lost. 

Treatment, — Treatment is very difficult and often has 
to be prolonged for months. In the first place a very care- 
ful local examination of all the parts should be made. 
If circumcision has not been done it is best to try this 
in the case of boys; in girls the adhesions around the 
clitoris should be broken up if any are found. The urine 
should be thoroughly examined and if there is too much 
acid found sweets should be cut down or eliminated from 
the food; if the child is taking beef juice or red meat this 
should be cut out of the diet for a time at least and the 
result should be watched carefully. More water should 
be given between meals to dilute the urine to a greater 
extent. If there are pinworms or eczema of the parts 
these should receive the proper treatment described for 
these diseases. All excitement should be taken from the 
child^s life and as much air and sleep in the open as possi- 
ble should be insisted upon with nonstimulating but nour- 
ishing food and a tonic if the child is anemic. 

Constant watchins: is essential if the habit is to be 



210 DISEASES OF THE NEEYOUS SYSTEM 

broken up. If the child uses his hands to practice self- 
abuse the wrists should be tied to the sides of the crib 
with broad tapes so the parts cannot be reached. If the 
habit is practiced by rubbing the thighs together with 
crossed legs then the legs may be tied or a special apparatus 
made to put around the legs and keep them apart. Some- 
times it is necessary to blister the inside of the thighs or 
vulva in girls to make them so sore that the habit is very 
painful and cannot thus be indulged in^ but this must be 
done by a doctor. The child may have to be kept entirely 
away from other children so as not to teach them the 
bad habit. If the habit is allowed to continue it may 
lead to forms of insanity, and the mother should spare no 
time, trouble, or expense in breaking it up if at all 
possible. The younger the child, the more hopeful the 
outlook for recovery. 



CHAPTEE IX 
INFECTIOUS DISEASES OF CHILDHOOD 

Aisr infections disease is a disease which is cansed by 
some special microorganism. We used to employ the term 
contagious disease when we meant a disease that was 
communicated only by direct personal contact of some 
sort;, as through the touch or the breath or skin^, but now 
contagious is no longer used in contra-distinction to 
infectious. Diseases transmitted directly from one person 
to another are best called communicable diseases. 

The infectious diseases most common to children are: 
scarlet fever^ measles^, German measles^ chickenpox, whoop- 
ing-cough, mumps^ diphtheria, and tuberculosis. Malaria, 
typhoid fever, epidemic cerebrospinal meningitis, influenza, 
smallpox, infantile paralysis, and congenital syphilis are 
also of this class, but not quite so common in early child- 
hood. Then there is a set of infectious diseases that aftect 
the intestines and stomach ; of this class summer diarrhea 
of infancy is the most frequently met with. 

In many of the infectious diseases the special germ 
that causes the disease has been identified without a 
doubt. In several of the other diseases there is still a 
doubt, but learned men and women all over the land are 
working in laboratories constantly, and every little while 
making wonderful discoveries, so that some day we hope 

211 



212 INFECTIOUS DISEASES OF CHILDHOOD 

to have all the germs that cause disease definitely identi- 
fied, and then we shall know exactly how to handle them, 
and be able to save many more lives among the little 
children. Many hundreds of cases of the dreaded disease, 
diphtheria, have been prevented and saved since the dis- 
covery of the diphtheria antitoxin, and if we could find 
such an antitoxin for the other infectious diseases there 
is no doubt but that many hundreds of other babies would 
be spared. 

Most of these diseases have what is called ^^a period 
of incubation,^^ in other words, the time which elapses 
between the exposure of the child to the disease and the 
time when the disease manifests itself. For a great many 
reasons it is very valuable for a mother to know when 
she may reasonably expect her child to ^^come dovm'^ with 
any of these diseases, if she happens to know that he has 
been exposed; she can tell then about how long he should 
be kept away from his brothers and sisters, or out of 
school, etc. Hence the following facts regarding the most 
common infectious diseases will be of service : 

Period of Incubation 

Scarlet Fever Average two to six days; 

Possible few hours to fifteen da3rs. 
Measles Average eleven to fourteen days ; 

Possible nine to twenty-one days. 
German Measles.. About fourteen days. 

Average seven to fourteen days; 
Whooping-cough.. Possible four to twenty-one days. 
Diphtheria Average five to seven days ; 

Possible two to twelve days. 
Mumps Average seven to fourteen days. 



MUMPS 213 



Chickenpox Average seven to fourteen days; 

Possible five to twenty-one days. 
Smallpox Average ten to twelve days; 

Possible seven to fourteen days. 
Influenza Average two to three days ; 

Possible seven days. 
Typhoid Fever ... Average seven to fourteen days. 

The other infectious diseases have no positive periods 
of incubation^ therefore after a child has been exposed to 
any one of them one cannot tell just when to expect the 
first symptoms. 

Mumps 

General epidemics of mumps are not often seen, but it 
is decidedly an infectious disease. It is characterized by 
the swelling of the glands at the sides of the face and 
neck which are called the parotid glands. Sometimes other 
glands are also involved. 

Causes, — The origin of mumps has been traced to a 
microorganism. 

Although children of all ages may have mumps, it is 
chiefly seen in those of the school age — especially between 
the ages of four and fourteen. Children are not so sus- 
ceptible to the poison of mumps as they are to many of 
the other infectious diseases; therefore even when they 
have been exposed to a case it is not at all certain that 
they will contract it. It is nearly always contracted by 
direct exposure, but it may possibly be carried by a tliird 
person, or by clothing. 

From the very beginning mumps is contagious, and con- 
tinues to be so for several davs after the swelling: has 
15 



214 INFECTIOUS DISEASES OF CHILDHOOD 

disappeared. It is usually safe to keep a case isolated 
three weeks in all^ or ten days at least after the swelling 
has disappeared. If a child has been exposed to a case 
of mumps and he is to contract it, he may do so at any 
time from three to twenty-five days ; from one to two weeks 
is the usual time. 

Symptoms, — In the majority of cases swelling is the first 
symptom. Loss of appetite, vomiting, pains in the back 
and legs, and considerable fever before the swelling is 
seen, may occur. These symptoms may last a day or two, 
and are followed by gradual swelling. In a mild attack 
the Temperature is generally 100° to 101"^ F. at first, and 
in a severe case it may be 102° to 104° F. 

Even before the swelling is very noticeable there is more 
or less pain on moving the jaws or on pressing over the 
parts. This is usually much increased by taking acids, 
such as vinegar or lemon, into the mouth. The lower back 
part of the jaw just below the ear is the point where the 
pain is the most severe. The disease may be limited to 
one side only; both sides may be involved at once, or one 
side may follow the other after several days or even longer. 
The gland will continue to increase in size for two or 
three days, then remain stationary for several more days 
and then gradually grow smaller. The swelling in a 
severe case may be very great. It extends upward behind 
the ear and forward onto the face in front of the ear, the 
center of the swelling often being the lobe of the ear. The 
position of the swelling should be remembered, for it often 
helps greatly in deciding the nature of the disease, and 
distinguishing it from other swellings in the neighboring 
regions. If one stands behind the patient the typical 



MUMPS 215 



swelling may be often well observed. The little glands un- 
der the jaw and under the tongue may also be swollen to 
some extent. 

The secretion of saliva is much diminished during the 
disease^, and the mouth is dry^ causing the child to be 
very uncomfortable. The patient suffers extreme pain 
on trying to eat and sometimes even to swallow ; the mouth 
can be opened only a little^ and often solid food cannot 
be taken at all. 

Treatment. — The treatment in mumps is simple. While 
there is any fever the patient must be kept in bed, and 
while any swelling lasts^ confined to one room. The bowels 
must be kept open by magnesia or some other simple 
laxative. The diet must consist of milk^ broths, and 
gruels while the fever lasts, and the swelling is very great ; 
acid fruits and other sour things should not be given, as 
they usually cause great pain. If the temperature is high 
alcohol sponge baths may be given and an icecap kept at 
the child^s head. For local treatment hot applications to 
the swollen glands will give more relief than any other 
remedy. A large compress or napkin wrung out of hot 
water 115° to 130° F., placed over the gland, then covered 
with oiled silk and held in place by two or three turns of 
a bandage, is often helpful in lessening the pain. If it is 
to be kept warm it will be necessary to change this dressing 
every twenty minutes or half hour. Warm oil on a piece 
of flannel may sometimes be used with benefit; an oint- 
ment of ichthyol — 10 to 20 per cent. — is sometimes used. 
The mouth, nose, and throat must be kept clean with 
some mild antiseptic solution and frequent drinks of cool 
water given to relieve the dry mouth and throat. 



216 INFECTIOUS DISEASES OF CHILDHOOD 

Complications. — The complications of mumps are not 
many or frequent. Sometimes painful swellings of other 
glandular organs occur, and in older children, especially 
boys, this complication may be rather serious. If this 
occurs there is usually increased fever, and perhaps a chill ; 
occasionally kidney disease may follow a case of mumps, 
but this is rare. Deafness has been observed to follow 
a number of cases of mumps, the nerve of hearing being 
involved, and hence deafness being permanent. 

Meningitis, heart disease, and pneumonia have all been 
known to occur with mumps, but they are rare complica- 
tions and need very seldom be dreaded. 

Many mistakes are no doubt made in diagnosing a case 
of mumps. It is often confounded with either adenitis of 
the neck or simple swelling of the lymphatic glands. If 
one will remember the location of the swelling in mumps 
and the fact that it extends onto the face in front of the 
ear as well as behind it, mistakes would not so often 
occur. When the lymphatic glands are involved the swell- 
ing is entirely below the ear and behind the jaw, and does 
not extend onto the face. These swollen lymph nodes may 
become very large and hard, then gradually absorb, or they 
may soften, and pus may form in them which will have 
to be let out by a doctor. 

It is always a mistake to open glands too early ; if this is 
done they take much longer to heal and are often very 
painful during the process. One should not be in a hurry 
to operate if there is any reasonable doubt as to the pres- 
once of pus. 

Disinfection, — It is not necessary to fumigate after a 
case of mumps. 



CHICKENPOX 217 



Chickenpox 

(Varicella) 

Causes. — Chickenpox^ or varicella, is an infections dis- 
ease very often seen among infants and children. It is 
exceedingly contagions and may possibly be carried by 
means of a third person, but it is generally contracted 
through direct exposure. The disease is characterized by 
an eruption of papules and vesicles, and it is in this erup- 
tion that the contagious poison of the disease is lodged. 
As a rule a child has but one attack of chickenpox in his 
life. After exposure generally seven to fourteen days 
elapse before the first symptoms are noticed, though they 
may be seen a few days earlier or later. 

Symptoms. — ^Generally an attack of chickenpox comes 
on without any warning, but sometimes there will be slight 
fever or general feeling of illness the day before the rash 
is seen. The eruption usually appears first on the face, 
scalp or shoulders, and looks like small red spots rather 
widely scattered; it spreads rather slowly over the body 
and arms, legs, hands and feet, and may often be seen in 
the mouth. One quite constant feature of the eruption is 
that the spots seem to come in crops, new spots appearing 
for several days, so that by the time the last have appeared 
the first have begun to dry up and have assumed a very 
different appearance; at the height of the disease all stages 
of the eruption may be seen on the same part of the 
body. 

The little red spots, which are at first very small, in- 
crease in size, becoming surrounded by a red area : some 



218 II^FECTIOUS DISEASES OF CHILDHOOD 

of them remain in this stage, but others go further, and 
it is then that the little vesicle is seen. Some of these 
vesicles are large and others quite small. When the 
vesicles begin to dry up this process usually starts in the 
center, giving the spots a slightly depressed appearance 
here. Next, crusts form, and these fall off one by one at 
any time from five to twenty days. If the spots have been 
deep a white scar may remain, but this does not often 
happen. 

The general symptoms are not severe. There is usually 
a little fever — 101° to 102° F. — which lasts one or two days 
while the rash is coming out rapidly. In very severe cases 
the temperature runs higher and lasts longer ; there may 
be considerable itching, and I have known of a few cases 
which showed a slight diarrhea. 

Treatment, — Little treatment is needed. It is best to 
isolate the case, especially if there are other young or 
delicate children in the family, and the child must be kept 
away from school until all the crusts have fallen off and 
the skin is perfectly clear and smooth again. While there 
is fever the child must be kept in bed on a fluid diet, with 
cool water to drink; a cathartic should be given so as to 
insure a free action of the bowels each day. Warm sponge 
baths may be given. Carbolized vaselin may be applied to 
the itching spots, and will somewhat allay the irritation. 
The child must not be allowed to scratch, as serious infec- 
tion may result. To prevent scratching, splints on the 
arms, mittens on the hands or tying the hands in bags may 
be tried. 

Disinfection. — It is best to very thoroughly clean the 
room at the close of the disease. 



VACCINATION 219 



Vaccination 
(Vaccinia) 

While vaccination cannot be spoken of as a contagious 
disease it is one that can be communicated by what is 
termed inoculation, and something about the process should 
be known to every mother. All leading physicians who 
treat children recommend vaccination. Mothers some- 
times ask^ "Why is vaccination necessary when we have 
so few cases of smallpox and the baby is not likely to be 
exposed ?^^ Because it is only by the constant practice 
of vaccination that the dread disease is kept under con- 
trol, and it is everyone^s duty to assist in keeping it out 
of the country. 

The best time to vaccinate the average healthy baby is 
during the third month; it is then well over before the 
teeth begin to be troublesome and can be better cared for 
than when the baby is older and more active. In young 
infants it is best to select the leg for the seat of vaccina- 
tion; if the child is old enough to walk or creep the arm 
may be chosen. The outer fleshy part of either arm or 
leg, and not near a joint, but about midway between them 
and on the left side rather than on the right, is the best 
spot to choose. A physician who will take pains to pro- 
cure fresh and pure vaccine virus must be asked to vaccinate 
the baby; the mother or nurse should not undertake it. 
The part selected must be caretully washed with soap and 
water, dried, and then washed with alcohol. A perfectly 
new, clean cambric needle should be used to make the 
scratches, which should be only about an eighth of an inch 



220 INFECTIOUS DISEASES OF CHILDHOOD 

long, and crossed by others the same length : three or four 
in each direction are enough. The vaccine virus should 
then be well rubbed into the spot as soon as a little blood 
is seen; then this must be allowed to dry before the part 
is covered. Either a clean bandage may be used to 
protect the sore from the shirt sleeve or stocking, or some 
soft linen may be basted inside the clothing. As it is best 
to keep the part perfectly dry a sponge bath is best while 
the part is sore. 

The average vaccination begins to ^^take^^ on the fourth 
or fifth day; there is an area of redness which is followed 
by the forming of a vesicle. By the ninth or tenth day 
it is fully formed; the redness around it may be two or 
three inches wide, with some swelling. The vesicle then 
either ruptures and discharges or dries to a crust, and the 
redness begins to fade. The crust or scab remains on 
from about one to three weeks, then falls off, and leaves 
a scar. Often young infants feel no general symptoms, 
but others have some fever for a day or two, and perhaps 
loss of appetite. 

When the vesicle breaks the part should be dusted with 
boric acid powder two or three times a day, or if there 
is a discharge of pus a two per cent, ointment of ichthyol 
may be applied on clean linen. Vaccination shields should 
not be used. The shield constricts the part, rubs into the 
wound and often causes much trouble and pain. If the 
part is kept clean and dry and the child not allowed to 
scratch, very little trouble need be anticipated. Vac- 
cination should be repeated about once in seven years, 
or more frequently, if there is an epidemic of small- 
pox. 



SCARLET FEVER 221 

Scarlet Fever 

Scarlet fever is one of the most dangerous of the con- 
tagious diseases. The child must be put to bed and kept 
there from the time of the first symptom until he has 
finished desquamating — until the skin has all peeled off. 
This will often take from four to six weeks. 

Causes, — The disease may be communicated by direct 
exposure^ by a third person, or by food, clothing, toys and 
books. The germs live a long time — cases have been traced 
back a year or more; therefore the greatest care must be 
employed in disinfecting all articles used, or else the things 
must be burned. 

Symptoms. — As a rule the first symptoms noticed are 
sore throat, vomiting, and high fever. Then within twenty- 
four or thirty-six hours the rash appears. This rash is 
seen first on the chest and abdomen; it is bright red in 
character and in very fine, red dots. So close are these 
dots that at a little distance it appears like a red blush. 
It is sometimes spoken of as a "boiled lobster^' rash. It 
usually spreads so that the entire body and face are covered 
with it, but in a few cases it is limited to only a portion 
of the body. It generally lasts from five to six days, but 
may disappear in a few hours. As the rash fades the 
skin begins to peel (or desquamate), and this may con- 
tinue for two or three weeks or even longer. The palms 
of the hands and soles of the feet, the fingers and toes 
are often the seats of extensive peeling; by means of this 
peeled-off skin the disease may be carried to another 
person. 

The appearance of the tongue and throat in scarlet 



222 INFECTIOUS DISEASES OF CHILDHOOD 

fever is quite typical. The throat is of a deep red color 
and may be quite swollen, while the tongue has little raised 
dots of red on it, which give it the name of strawlerry 
tonguer— it looks so much like a strawberry. As a rule 
the fever is quite high during the time the rash lasts as well 
as just before it appears; in many cases it will reach 105° 
and remain between this and 102° F. for some days. In 
such cases there is often delirium and the child appears 
very ill. Other milder cases may have a fever of only 
101° or 102° F. as the highest, and these are much less 
serious than where the fever is high. 

Treatment. — When caring for a case of scarlet fever the 
mother or nurse must be isolated with the patient and wear 
a wash dress and cap. Other children must be kept from 
school or sent away before they have been exposed. 

Until all fever has left, the patient must be kept on 
a milk diet; if the child is bottle-fed the usual formula 
must be diluted at least one-half. Older children may 
take kumyss or whey at times in place of the milk, for 
the sake of variety, and orange juice may be allowed twice 
a day. As the fever leaves, broths, cereals, junket, milk 
toast, coddled egg (if the urine is normal) and a little 
ice cream may be allowed, but nothing more substantial 
for three or four weeks. The bowels must be kept open 
daily by the use of an enema or the milk or citrate of 
magnesia. Other medicine is not, as a rule, needed. This 
must be left to the doctor in each case, however. To con- 
trol the fever an icecap may be placed at the child's head, 
especially if he does not sleep well. 

Sponge baths of tepid water with two tablespoonfuls of 
alcohol to the basin of water may also be given. That the 



SCAELET FEVER 223 

rash will ^^strike in^^ is a foolish belief without real founda- 
tion. After the daily sponge bath it is well to rub the 
child with melted cocoa butter or vaselin; this will allay 
the itching so often present and also keep the scales of skin 
from flying about. The urine must be carefully watched 
and frequently tested by the doctor; plenty of water must 
be given between th^ regular hours of milk meals; the 
nose should be sprayed with a mild antiseptic wavsh or 
oil; the throat may be sprayed or the child may gargle — 
if he is old enough to do so, a mild antiseptic gargle or 
wash should be used. If the child has teeth they must 
be brushed or wiped off two or three times a day with 
boric acid solution. The mouth and throat must never 
be neglected in these cases. 

Complications. — The complication we most dread in 
scarlet fever is nephritis or disease of the kidneys; the 
milk diet and rest in bed will many times prevent this, 
however. Otitis or inflammation of the ear is another 
frequent complication. When the child complains of ear- 
ache hot flannels must be applied or a hot water bag, 
and if the pain still continues a doctor may have to make 
a little opening in the drum membrane. Adenitis may 
occur, especially in the neck; this is simply a swelling of 
the little s^lands situated there, and a small icebasr mav 
be tried. This should be kept constantly applied and will 
often reduce the swelling. Swelling of the joints some- 
times occurs as a complication; if this takes place they 
should be wrapped in cotton batting and kept at rest as 
much as possible. Many times the doctor will order a 
soothing lotion to be applied to the joints before the cotton 
is wrapped around them. 



224 INFECTIOUS DISEASES OF CHILDHOOD 

Disinfection. — At the close of a case of scarlet fever the 
child must be put in a tub and thoroughly washed with 
warm water and soap. He must then be bathed with a solu- 
tion of bichlorid of mercury (1-5^000)^ hair and all, care- 
fully dried and wrapped in a fresh blanket, carried into 
another room and dressed in clean clothing. He should 
be given airings in the house for a few days before going 
out. 

The room and all articles that have been used must 
be thoroughly cleaned and carefully fumigated at the end. 

Measles 

With the exception of smallpox, measles is the most con- 
tagious of the infectious diseases. Children of all ages may 
have it, but it is not so common in babies under one year 
of age as it is later in childhood. 

Causes, — Measles is usually contracted by direct exposure 
to a person already having the disease, but it is just pos- 
sible to carry it by means of clothing or other articles, 
or by a third person. The germs of measles do not live 
as long as do scarlet fever germs. 

A child who has been exposed to a case of measles may 
be expected to show signs of it at any time from nine to 
twenty-one days after the exposure. It is contagious from 
the appearance of first catarrhal symptoms until the child 
is entirely well at the end of two or three weeks ; in most 
cases twenty-one days are allowed as the contagious period 
of measles. If there are other children in the family, 
they must be kept from school while measles is in the 
house, and the child having measles must be isolated as 
closely as possible with his mother or nurse. 



MEASLES 225 



Symptoms. — ^In the average case of measles the symp- 
toms very much resemble those of a common cold: there 
is feverishness, running nose and eyes^ a dry cough, and 
a general feeling of illness, the child being cross and out 
of sorts without knowing just why or just what he wants. 
Sometimes the temperature runs as high as 103° or 104° 
F. and there is a slight chill. On the second or third 
day the temperature will usually fall to normal and the 
child will feel better, though the appearance of a cold 
still persists. Then, as a rule, on the fourth day the rash 
will appear and the temperature become high again. 

The rash is first seen on the face, and behind the ears ; 
from here it extends over the rest of the body and ex- 
tremities. It remains well out for about two days, then 
begins to fade in the order of its appearance. As the 
rash fades the skin begins to peel in very fine, branlike 
particles, quite different from the large pieces seen in 
scarlet fever. This takes ten days or less, but causes 
considerable itching of the skin. With the fading of the 
eruption the child will feel much better and the fever 
will gradually drop. There is often some diarrhea with 
measles, and sometimes a slight sore throat. 

The character of the rash is quite distinctive; at first 
it appears as small, red spots, but soon enlarges into 
blotches, leaving distinct white areas of normal skin be- 
tween the red blotches. It assumes a crescent shape later. 
Many of the blotches or spots run together, making larger 
patches. The face is often a good deal swollen while the 
rash is at its height, and the eyes are almost closed at 
times. 

There is often a peculiar eharaeteristio odor about a 



226 INFECTIOUS DISEASES OF CHILDHOOD 

patient who has measles; if the case is a severe one this 
is especially noticeable. The cough is usually quite trouble- 
some; the tongue is thickly coated and the breath is foul; 
the urine is usually highly colored and may be scanty; 
the eyes are inflamed and watery^ or they may even have 
a discharge of pus if they have not been properly shielded. 

Little red spots with a bluish-white dot in the center 
may sometimes be seen in the mouth and even before the 
rash appears. These are called Eoplih's spots, after the 
physician who discovered them. 

Treatment, — A child with measles must be put to bed 
and kept there^ away from all the other children. It is 
safer to keep in bed for fully two weeks^, but in mild 
cases with no complications he may get up and sit in 
a chair after the tenth day. While the fever lasts the 
diet must consist of diluted milk and broths; then milk 
toast and cereals may be added^ with a gradual return to 
the usual food. 

The room should be slightly darkened as long as the 
child shows any weakness of the eyes^ and he should be 
kept moderately warm but not overloaded with bed cloth- 
ing. A dose of castor oil may be given if the movements 
are loose^ or magnesia if they are constipated. If there is 
very high fever with restlessness or delirium, tepid sponge 
baths with alcohol in the water should be used, and an 
icecap kept on the child's head. 

The mouth and teeth should be kept very clean with a 
mild antiseptic mouthwash. Inhalations of steam from a 
croup kettle often greatly relieve the troublesome cough, 
and are better than drugs. Plenty of cool water should 
be given. Boric acid should be used for an eye wash, some 



WHOOPING-COUGH 227 

of this being dropped into the eyes several times a day^ and 
the lids kept very clean. 

Great care must be taken to keep the child out of drafts, 
but the room must be well ventilated. When the child is 
allowed out of bed he must not sit on the drafty floor. A 
rubbing of the entire body with cocoa butter each day after 
a warm sponge bath relieves the itching of the skin. 

Complications. — Bronchitis, bronchopneumonia, laryn- 
gitis, pharyngitis, earache or abscess in the ear, diarrhea, 
and severe inflammation of the eyes with a discharge of 
pus, are the most frequent complications. If the fever is 
very high there may be symptoms of brain trouble or even 
a convulsion. 

Disinfection. — At the end of the disease the child should 
be bathed in a soap-and-water bath, then carefully bathed 
in a bichlorid of mercury solution (1-5,000), hair and all, 
wrapped in a clean blanket and dressed in fresh clothing. 
The room in which the child has been ill should be thor- 
oughly fumigated by a competent person, and then cleaned. 

Whooping-cough 

Causes. — Whooping-cough is a very common and infec- 
tious disease. It is caused by a specific microorganism. 
Children of all ages may contract it, but young babies are 
especially liable to have it if exposed. From the very 
beginning of the first stage whooping-cough is conta,i2:ious, 
and continues so while there is the least whoop. Gen- 
erally it is best to keep a child with whooping-cough away 
from other children for two months. It is very rarely car- 
ried by a third person or by means of clothing. After 



228 INFECTIOUS DISEASES OF CHILDHOOD 

exposure one may expect a child to be affected with 
whooping-cough at any time from seven to sixteen days. 
Symptoms, — There are two distinct stages of whooping- 
cough. The first is the catarrhal stage; this averages 
about ten days. For the first five or six days the symp- 
toms are those of an ordinary cold and cannot be distin- 
guished from this^ but generally after this time the cough 
comes in paroxysms^ although no whoop may yet appear. 
There may also be slight temperature. The second stage 
of the disease is known as the spasmodic stage; here the 
paroxysms of coughing are accompanied by the typical 
whoop^ although in cases of young babies no whoop at all 
may be present — simply the severe paroxysm. Many times 
an older child can foretell when a paroxysm is about to 
take place and will run to his mother or take hold of a 
chair for support. He becomes red or purple in the face^, 
his eyes protrude^ a number of explosive coughs take place 
and then the typical whoop. This may be repeated several 
times in a single paroxysm, when a mass of thick mucus 
is brought up or the child may vomit; the latter is es- 
pecially likely to happen if the child has been recently 
fed. In very severe cases there may be a nosebleed or 
even a convulsion. According to the severity of the case 
there may be many or few paroxysms in twenty-four hours ; 
usually they are more frequent at night. This severe, spas- 
modic stage lasts generally for about one month, but may 
. be much longer, especially during the winter months. Even 
after the disease is over, if the child takes cold or has an 
attack of bronchitis there may be a paroxysmal cough 
with it, or even a whoop. In the average case the 
paroxysms become less frequent, the whoop gradually 



WHOOPING-COUGH 229 

disappears^ and the cough again resembles that of a cold 
or bronchitis until it stops. 

Complications, — Hemorrhages^ pneumonia, diarrhea and 
vomiting, and convulsions are the most frequent compli- 
cations of whooping-cough. 

Treatment, — No distinct cure for whooping-cough has 
been found. A vaccine is now being tried and is thought 
to help by numerous doctors. Drugs often do more harm 
by upsettmg the stomach than they do good in relieving 
the cough. The chief thing to be considered is to keep 
the child as well nourished as possible and give him plenty 
of pure^ fresh air. It is often well to take him away for 
a complete change of air; this will sometimes consider- 
ably lessen the duration of the disease. At any rate^ the 
child should spend as much time as possible in the open 
air every day and sleep in a well-ventilated room at 
night. 

The question of giving the child sufficient nourishment 
is often a serious one, because so much food will be 
vomited. It may be necessay to feed the child a little more 
frequently than when he is well. After a paroxysm of 
coughing, when the mucus and perhaps any food that has 
been in the stomach at that time has been expelled, a glass 
of milk or some broth with perhaps a little zwieback — 
if the child is old enough to take it — may be given and 
will many times remain down; another paroxysm is not 
likely to occur right away. Food which is easily digested 
and contains the most nourishment should be chosen. In- 
fants should be given peptonized milk in place of the 
usual formula, as this will be digested more rapidly. If tlie 
child seems to be losing strength it may be necessarv to give 
16 



^30 mFECTIOUS DISEASES OF CHILDHOOD 

some form of predigested beef besides the regular meals. 

A croup kettle with a few drops of creosote on the 
sponge may be used for inhalation or be kept burning a 
part of the time in the room. The bowels must be kept 
well open; milk of magnesia is excellent for this purpose^, 
and an occasional dose of castor oil should be tried. If 
there is difficult breathing or any tendency to bronchitis 
with the whooping-cough^ a large mustard paste may be 
placed on the chest once or twice in twenty-four hours 
until the skin becomes slightly red. The child must be 
kept in the house for at least a day after one of these 
pastes is administered^ however. 

Patent medicines to be rubbed on the chest or taken 
internally should be avoided. If bronchitis is present a 
sponge bath will be best^, otherwise the tub bath may be 
given as usual. 

In some cases a belt that will support the abdomen has 
given relief. AH of these measures should be tried be- 
fore drugs are resorted to. If it is decided to try medi- 
cine internally a physician who understands the nature 
of the child should be asked to prescribe^ and should care- 
fully watch the patient. 

It may be well to say a word here about the unwise way 
in which mothers willfully expose their children to diseases 
like whooping-cough and measleS;, just to "get them over 
with.^^ This should never be done. Both these diseases are 
capable of causing death and should be avoided when pos- 
sible. 

Disinfection, — It is best to give the rooms in which the 
child spends most of his time an occasional fumigation^ 
during the disease as well as at its close. 



GERMAN MEASLES 231 

German Measles 
(Rubella) 

This is an infectious disease^ generally very mild in 
character^ and quite distinct from measles. Children of 
any age may have it^ but infants under six months are not 
so liable to contract it as are older children. 

Causes, — At any time during its course another child 
may take the disease if exposed to it^, but it is especially 
contagious during its early stages. It is nearly always 
contracted by direct exposure to the person who has the 
disease^ and not carried by a third person nor by articles 
like books^ toyS;, etc. 

If a child has been exposed to German measles one 
may expect him to show the first symptoms at any time 
from the eighth to the sixteenth day^, although cases have 
been known to develop as early as the fifth day or as late 
as the twenty-first. 

Symptoms, — Generally the first symptom noticed is the 
rash^ but occasionally a slight fever, catarrhal symptoms, 
or a general feeling of illness precedes the rash. Even 
vomiting, headaches, or convulsions have been known to 
occur first, but these cases are not common. 

The eruption generally appears first upon the face, then 
very rapidly spreads over the entire body, the legs being 
the last to be covered, so that by the end of one day, at 
the most, the rash is fully developed. In other cases, only 
a part of the body is covered by the rash, but nearly al- 
ways the face is involved. The appearance of the rasli is 
variable; sometimes it resembles that of real measles: and 



232 INFECTIOUS DISEASES OF CHILDHOOD 

again it looks more like scarlet fever. The majority of 
cases have a pale red rash with small^ distinct spots which 
may run together^ especially on the face^ and form irregu- 
lar blotches. When the scarlet fever type is seen there will 
be a fine rash, almost a red blush over the skin. Sometimes 
the rash is of a raised character so as to give the skin a 
shotlike feeling when the hand is passed over it. The 
rash lasts, as a rule, three days, but may fade sooner, dis- 
appearing quite rapidly and in the manner in which it 
first appeared. Often a brownish appearance is noticed on 
the skin after the rash fades, and many times the skin 
comes off in very fine dustlike particles : this cannot al- 
ways be distinguished except by an expert observer. When 
it occurs it usually lasts from one to five days. 

Other symptoms present are some fever, generally not 
above 102° P., and often not more than 100° F.; this 
may last for one or two days — rarely longer — and the 
patient may complain of a slight sore throat. The symp- 
tom that is the most characteristic about this ^ disease is 
the swelling of the glands at the sides and back of the 
neck. These are called postcervical glands, and are the 
main feature which will enable one to distinguish this 
disease from measles or scarlet fever, when the rash re- 
sembles very much one or the other of these diseases. At 
the height of the disease this swelling is the most marked, 
then gradually subsides as the patient recovers. 

Complicatians. — Very rarely are there any complica- 
tions to this disease, the child usually making an un- 
eventful recovery. 

Treatment. — Compared to any of the other contagious 
diseases the treatment required is very little. The child 



GERMAN MEASLES 233 

should be put to bed in a room by himself. It is so dif- 
ficult to be sure that the patient really has German 
measles, and nothing more serious, that very strict isola- 
tion should be observed, at least for a few days, until all 
the symptoms develop and a more positive diagnosis can 
be made. Other children should be kept from school while 
there is the least doubt as to the nature of the disease, 
and not be allowed to enter the room. 

The child should be given a dose of castor oil or a dose 
which is equally effective to move the bowels, and while 
there is any fever a milk diet is best maintained. As he 
improves, orange juice, broths, cereals, and toast may be 
added, with a little vanilla ice cream; then a poached or 
coddled egg may be given and the regular diet gradually 
resumed. A baby young enough to take a bottle should 
have the usual formula diluted a little, at least while the 
fever lasts. Breast-fed babies may be given an ounce of 
barley water or plain water just before each nursing, and 
kept at the breast ten or fifteen minutes instead of twenty. 

As in all cases of infectious diseases the mouth, nose, 
and throat of the child must be carefully attended to. If 
secretions are allowed to harden and block the nose the 
child will be very uncomfortable; therefore at least twice 
daily a spray of an oily antiseptic substance must be used. 
The child should be trained to blow his nose thoroughly 
several times a day. The mouth and throat must be 
sprayed several times daily with boric acid or some other 
mild antiseptic solution ; the teeth must be thoroughly 
brushed or wiped off with a soft cloth at least twice daily. 
The urine should be analyzed. 

A warm sponge bath may be given and an inunction 



234 INFECTIOUS DISEASES OF CHILDHOOD 

with olive oil or cocoa butter if there is any itching of 
the skin. The swollen glands are best left alone. This 
is practically all the treatment needed in the majority 
of cases. If special symptoms develop the doctor must 
be asked to prescribe in each case. 

At the end of ten days or two weeks the patient is 
usually well over the disease and may have a bath^ be 
dressed in fresh clothings and go about the house as 
usual; then outdoors on the first sunny day. 

Disinfection. — It is not necessary to fumigate the room 
in which the sick child has been <3onfined. It should be 
thoroughly cleaned and aired. 

Diphtheria 

Causes. — Diphtheria is an infectious disease caused by 
a bacillus named after its discoverers, Elebs-Loeffter. The 
disease may be contracted by direct exposure, by a third 
person, or by articles of clothing, toys, wall-paper, milk, 
etc., and the bacillus is capable of living a long time. 

Symptoms. — It is characterized by the formation of a 
membrane whose usual site is on the tonsils or some part 
of the throat, but it may be present in the nose, the larynx, 
or, in fact, any mucous membrane. 

After being exposed to diphtheria a child may be ex- 
pected to show symptoms of it in from two to five days; 
generally within a week after the exposure the disease will 
be well developed. One attack from diphtheria does not 
prevent a child from having another — it rather renders 
him more susceptible. 

Unless the mother has formed the habit of regularly 



DIPHTHERIA 235 



examining her child's throat several times a week the dis- 
ease may be well advanced before it is suspected. Es- 
pecially is this true in the case of very young children 
who cannot tell where the trouble lies. Often a dis- 
charge from the nose of mucus mixed with blood will in- 
dicate an attack of diphtheria; the little glands at the 
side of the neck may be swollen, and there may be some 
fever, but this varies greatly, and in a straight case of 
diphtheria is not likely to be high except in very young 
babies. The membrane in the throat presents a variety 
of pictures; it may be so slight as to resemble a faint 
gray veil on one tonsil, or both sides of the throat may 
be covered with a thick, grayish-yellow patch and all sur- 
rounding parts may be very much swollen. While there 
is usually some pain on swallowing this is not nearly so 
great as in an ordinary ^^sore throat'^ or tonsillitis. If 
not checked by proper treatment the membrane is liable 
to spread rapidly, often extending downward into the 
windpipe and causing membranous croup or laryngeal 
diphtheria. 

Sometimes it may start in the larynx and then gives rise 
to hoarseness and later to very difficult breathing, the 
child appearing to suffer greatly from croup; this is the 
most dangerous kind of diphtheria, and one in which very 
quick action is imperative if the child is to be saved. In 
these severe cases of laryngeal diphtheria very large doses 
of antitoxin are needed, and they must be repeated in a 
few hours if required. It may also be necessary for the 
doctor to put a little gold tube into the windpipe to ad- 
mit air. 

Treatment. — As soon as a mother notices anv white. 



236 INFECTIOUS DISEASES OF CHILDHOOD 

gray, or yellow spots in her child^s throat she should at 
once send for a doctor; she should not attempt to treat 
a sore throat of any kind by herself. The child should at 
once be put to bed and completely isolated until a posi- 
tive diagnosis can be made by the doctor. If this is done 
the other children in the family may escape the disease 
if it proves to be diphtheria. In many cities the Board 
of Health furnishes little glass tubes and a swab with 
which to take a culture of a child's throat; after taking 
the culture the doctor sends the tubes to the Health De- 
partment, where they are put in an incubator and de- 
veloped, then examined under the microscope, and a re- 
port sent to the doctor as to what kind of sore throat the 
child has. All this is a very great assistance and makes 
the diagnosis and treatment much more accurate. In 
smaller places the doctor may examine the culture him- 
self, or if this is impossible he will have to treat the 
child on the general appearance of the throat and symp- 
toms present. 

Antitoxin given in full doses and early in the disease 
is the best treatment. Nearly all up^to-date physicians 
now believe in the use of it, because they have seen its 
wonderful results. In many hundreds of cases I have 
seen it used with the greatest benefit; many times it has 
saved otherwise hopeless cases, and I have never seen any 
unfavorable results from the use of it. Occasionally an 
attack of hives will follow, but this is soon cured and the 
discomfort is comparatively slight when one considers the 
great good the antitoxin has done. 

Sometimes in twenty-four hours the membrane will have 
entirely disappeared from the throat. Other members of 



TYPHOID FEVER 237 

the family should also receive a smaller or immunizing 
dose of the antitoxin to prevent them from contracting 
the disease. Aside from this very little treatment is 
needed. The child^s bowels should be made to move 
every day during the disease by some simple laxative like 
magnesia; it is often advisable to give a dose of calomel 
at first, followed by magnesia the next morning. The 
mouth and teeth must be kept clean, and a mild antiseptic 
spray may be used if the doctor thinks best. The urine 
should be examined by the physician. 

The child must be kept quiet in bed, and the diet should 
consist of milk and broths at firsts with a gradual return 
to solid food. If fever is present it is best controlled by 
sponge baths with a little alcohol in the lukewarm water; 
this is better than drugs. The child should be kept iso- 
lated until a culture can be taken from the throat, which 
will show the absence of any diphtheria bacilli. Some- 
times this lasts two weeks, sometimes much longer. 

Complications. — The complications of diphtheria which 
we most dread are paralysis, bronchopneumonia, kidney 
disease, and heart disease. If, however, antitoxin is given 
early and in sufficient quantities the child is likely to es- 
cape these troubles. 

Disinfection, — The room must be carefully fumigated 
at the close of the disease, and the child bathed and freshly 
dressed before he is allowed to mingle with other children. 

Typhoid Fever 

Typhoid fever is not common among young children, 
but as they grow older cases are often seen. 



238 INFECTIOUS DISEASES OF CHILDHOOD 

Causes. — This disease is caused by a special bacillus 
which may be seen under the microscope. It is most often 
contracted by drinking impure water or (less frequently) 
milk. Some foods have also been known to harbor the 
typhoid bacillus — oysters^ cheese^ and butter. 

Symptoms, — The typhoid fever bacillus may be lodged 
in the system several weeks before the symptoms begin 
to appear. Even then it is often very difficult to surely 
tell whether the child is suffering with typhoid fever. It 
may begin with general lassitude, headache, and a gradual 
rise in the temperature, as in the case of adults, or the 
onset may be quite sudden, with vomiting, fever, and 
prostration. In many cases it is mistaken for an acute 
attack of indigestion. Diarrhea is present in about half 
the number of cases, while in other cases there is consti- 
pation. The abdomen is often distended and somewhat 
tender, the spleen is enlarged and there is considerable 
prostration, the child growing weaker as the fever grows 
high, and the loss of flesh is quite steady and marked. 

Typhoid fever has an eruption peculiar to itself, which 
may be found in a little more than one-half of the cases. 
This eruption is most often present at the beginning of 
the second week of the disease and should be looked for 
especially on the abdomen. It consists of small, rose- 
colored spots which come in crops and last about three 
days — then they fade and another crop appears; this may 
be continued for a week. If there is a relapse of the fever 
there is a return of the spots also. 

In cases resembling the adult type of typhoid fever 
the temperature runs a typical course. It generally grows 
higher every day for a week, fluctuates from one to three 



TYPHOID FEVER 239 

degrees the second week^ and then gradually drops the 
third week, often reaching normal at the end of this time. 
In other cases among young children the temperature does 
not run the typical course but jumps at once to quite a 
height. In mild cases we may expect the temperature to 
be 103^ or 104° F. when at its highest point, and in se- 
vere cases to be 105° or 106° F. Eelapses not infre- 
quently occur. 

The nervous symptoms in children may be quite marked ; 
there is often delirium, headache, or stupor. Hemorrhages 
from the bowels and perforations of the intestines are 
quite rare in children. 

There is a certain test of the blood in typhoid fever 
which is often of great value in deciding what the disease 
is. This is called Widal serum test and must be made 
by an expert doctor. It is not always found even in true 
cases, but when it is found there can be no further doubt 
of the nature of the disease. Sometimes it is necessary 
to make this blood test many times before it can be found 
positively, and the mother should always be willing to 
have the doctor take a specimen of the blood of the child 
as often as he deems necessary. The urine should be 
tested also and may reveal the nature of the disease quite 
early in the attack. 

Treatment. — In the treatment of typhoid fever abso- 
lute quiet and rest in bed are essential. No matter how 
mild the attack, the child must be put to bed at once 
and kept there while there is the least fever and for sev- 
eral days after this period. Everyone shoukl bo barred 
from the sickroom except the one needed to nurse the 
child. 



240 mFECTIOUS DISEASES OF CHILDHOOD 

The diet must be fluid for three or four weeks. Milk 
in some form is usually given every three hours. For 
young children this should be diluted; or kumyss, mat- 
zooU;, fermilaC;, and similar fluids may be used as a 
change. It is often advisable to peptonize the milk partly, 
or to add Vichy to it if the stomach is at all irritable. 
Pure water should be given between meals. A number of 
doctors within the last few years have given their patients 
gruels made from rice, wheat, or barley, flavoring these 
with a little mutton or chicken broth and cutting off all 
milk while the fever lasts. The gruels may be dextrinized 
if they seem to cause any extra gas or distension of the 
abdomen. Treatment with typhoid serum, both for the 
patient and other members of the family, is advisable. The 
physician must give this treatment himself. 

The fever should be controlled by cool sponge baths ; an 
icecap, or, if it is very high, a cold pack may be given. 
Whenever the temperature reaches 103° F. it is usually 
well to employ one of these methods to reduce it. They 
are less exciting and exhausting to the little patient than 
a full tub bath. Medicines are sometimes needed for the 
bowels or other symptoms, but they must of course be 
given strictly in accordance with the doctor's orders. 

Disinfection, — All movements from the bowels and also 
the urine must be carefully disinfected in a solution of 
bichlorid of mercury — 1-1,000 — ^before they are thrown 
down the closet. Bed linen, nightdresses, etc., should also 
be disinfected and then boiled separately from the cloth- 
ing of the rest of the family for two hours. The nurse 
must be careful to wash her hands thoroughly in soap 
and water after handling the patient, and disinfect them 



MALARIA 241 



frequently. At the close of the disease disinfection of 
patient, nurse and sickroom is required. 

Malaria 

Babies and children of all ages may have malaria. It 
is most frequent in the spring and autumn, but may oc- 
cur at almost any season. 

Causes, — Malaria is classed with the infectious diseases 
because it is caused by a special microorganism. This is a 
little parasite that lives on the blood and may cause either 
the acute or the chronic form of malaria. Several va- 
rieties of this little parasite are known, and according to 
the particular kind present in the blood, the fever and 
other symptoms, they present different pictures. For in- 
stance, when a chill followed by fever is noticed every 
day we may know that one particular kind of parasite is 
causing the trouble; another gives these symptoms on 
every other day; another every seventy-two hours; still 
another causes a very irregular fever. A certain kind of 
mosquito carries the malarial parasite and then gives it 
to persons through its bite. Certain localities where there 
are marshes and stagnant water abound in malaria. By 
draining off the water or using petroleum where the mos- 
quitoes breed most malaria is often stopped in a given 
district. 

Sijmptoms. — ^In older children malaria gives much the 
same symptoms as in adults, but in young babies it is 
often difficult to make a diagnosis, the symptoms are so 
irregular. The usual course of the disease in older chil- 
dren is as follows: The child may feel generallv uneom- 



242 INFECTIOUS DISEASES OF CHILDHOOD 

fortable for a short time^ have a headache^ or even vomit. 
This will be followed by a chill, the patient complaining of 
feeling very cold; the teeth may chatter and the lips and 
hands become blue; there will be a burning fever, the 
temperature often running to 105° F. Next the sweat 
will appear, the child being in a profuse perspiration. All 
these stages will appear at about the same time every day, 
according to the kind of parasite present. 

The regularity of the fever and other symptoms is the 
chief point in making the diagnosis, before the blood is 
examined. Young babies seldom have a chill or sweat; 
they often show disturbances of digestion and irregular 
fever which may run very high; sometimes there are con- 
vulsions. The spleen is nearly always enlarged, the ap- 
petite poor, and the tongue coated. 

When malaria has become chronic the child becomes 
very white, feels drowsy and cross much of the time, and 
is generally miserable. Many mothers dose their chil- 
dren for worms when they really have malaria; it is un- 
wise to give ^Vorm medicine^^ until after the blood has 
been examined for malaria by a competent doctor. 

Treatment. — The treatment of malaria consists in mak- 
ing the child as comfortable as possible during the chill 
by means of blankets and hot water bags, by the use of 
cool sponge baths during the fever, and by changing the 
clothes for dry garments during the sweat. Young babies 
should have the usual food diluted and drink plenty of 
cool water while they have any fever. Older children 
should take easily digested foods of a liquid or semisolid 
variety. 

There is one medicine that is really a specific for ma- 



MALAEIA 243 



laria; this is quinin. Children^ as a rule, stand this well 
and can take larger doses in comparison to their age than 
adults. In young babies the drug sometimes causes vomit- 
ing, and in such cases it is best to give it at night when 
the baby is taking no food. Before any quinin is given 
it is an excellent plan to give small, repeated doses of 
calomel — one-tenth of a grain every hour for ten doses is 
often ordered even for a baby six months old — ^but in 
every case the family doctor must be the one to prescribe 
this as well as the quinin which follows it. Mothers do a 
great deal of harm by dosing their children themselves ; 
they should do all they can by giving proper food, baths, 
fresh air and proper clothing, but when it comes to drugs 
they should let the doctor prescribe, as the responsibility 
is his in the end. 

The quinin to be given must depend upon the age and 
condition of the child. Small repeated doses given in a 
watery solution are usually best for babies where there 
are no distinct paroxysms; and they take this very well. 
In older children the taste must be disguised by means 
of various flavors, such as orange, sarsaparilla, etc. There 
is now a tasteless form of quinin often prescribed. 

Quinin in capsules may be given as soon as a child is 
old enough to swallow them, but quinin pills should not 
be given. Chocolate quinin tablets may be given after 
the fever is under control and a less active form of medi- 
cine is needed, but they are not very effectual during a 
severe attack. When a child has the adult type of ma- 
laria larger doses given several hours before the expected 
chill may be tried. After the quinin is stopped an iron 
tonic should be given for some time. 



244 INFECTIOUS DISEASES OF CHILDHOOD 

Mothers should always be willing to allow their doctor 
to make an examination of the child's blood whenever he 
deems it necessary. The hurt to the baby is very slight 
— not more than a prick from a needle — ^and it may save 
weeks of illness and suffering. 

Tuberculosis 

Causes. — Tuberculosis is caused by a special bacillus, 
and is, therefore, an infectious and communicable disease. 
It affects not only the lungs but may involve also any 
structure in the body. In children the glands of the neck 
and the bones are very frequently affected as well as the 
lungs, intestines, and other organs. 

The causes of tuberculosis are many. In a large per- 
centage of cases the disease or the tendency to it is in- 
herited; in others it is contracted otherwise; from living 
in rooms in which another person has lived who has had 
the disease, or it may develop after one of the other in- 
fectious diseases of childhood. The most frequent method 
of contracting tuberculosis is by means of the sputum 
from a person afflicted w4th the disease. The bacillus is 
contained in this sputum; the sputum is carelessly dis- 
posed of, dries, and the little bacillus flies about to be 
inhaled into the delicate lungs of the poor baby, who 
then contracts the disease. Babies and children of any age 
may have tuberculosis. It is claimed that milk from tu- 
bercular cows or women may cause tuberculosis in the baby 
who takes this milk. 

Symptoms, — As the symptoms of tuberculosis are so 
varied they cannot be given in detail here. One type of 



TUBEECTJLOSIS 245 



tuberculosis much resembles marasmus^ so often seen in 
infants; there is a gradual wasting, anemia, with gener- 
ally very little cough or fever, unless these develop to- 
ward the end of the disease. Other cases show more dis- 
turbance of the digestive tract. Other children often have 
symptoms more like adults; there may be irregular fever 
or even night sweats; then the cough and signs will be 
found in the lungs, and later hemorrhages. 

Tuberculosis of the glands of the neck is very often 
seen in childhood. These glands will remain enlarged 
for a very long time; then they may break down and have 
to be removed, when they will often be found full of a 
cheesy substance. Many times in a child who has tuber- 
cular glands of the neck no other part of the body will 
be involved. 

One of the most common forms of tuberculosis of the 
bones is what we know as Pott's disease. Many of the poor 
little humpbacked children whom we so often meet are 
suffering from this dread disease in the bones of the spine. 
Hip-joint disease is another form often met with in chil- 
dren. When tuberculosis attacks the brain we see tuber- 
cular meningitis. 

Treatment. — The treatment of tuberculosis is now much 
Detter understood than it was a few years ago, and the 
cases are not considered necessarily fatal. It is needless 
to say that a child with any of the forms of tuberculosis 
should be constantly under the care of a good physician, 
but there is much that the mother may do to prevent the 
disease from becoming active if the child has a tendency 
to it, or to help cure it if it has once become established. 

In the first place, if the mother herself is tubercular it 
17 



246 INFECTIOTTS DISEASES OF CHILDHOOD 

will not be safe for her to nurse her baby. She should 
either secure a very healthy wetnurse or else give the 
child cow^s milk properly modified. If there are other 
members of the family who are tubercular they should 
not be allowed to come in close contact with the baby nor 
to sleep in the same room with him. The substance ex- 
pectorated should be put into paper cups and immediately 
burned. ISTever under any circumstances should the baby 
be allowed to be kissed by the person suffering with the 
disease. All the beddings, clothing, etc., used by the sick 
person should be burned, keeping everything of his as sep- 
arate as possible from that of the rest of the family. 

A baby who inherits the tendency to tuberculosis or 
who has shown the first symptoms must spend the greater 
part of his time in the fresh air ; if this is done the chances 
are that the disease will not spread further. Of course, it 
is best to take the child to one of the numerous places in 
the country where the air has been found especially good 
for tubercular persons, but this is not possible for every- 
one. 

The child should be taught to sleep outdoors in a tent, 
if possible, or, if not, in a window-tent. For a baby or 
young child a skillful father (or a carpenter) may contrive 
a safe and useful little window sleeping-box which has an 
awning over it to protect the child from snow and rain 
in winter and from the sun in summer. A sleeping-bag 
should be used and a woolen hood for the head when the 
weather is cool; hot water bags may be also employed. 
This open-air treatment is really wonderful in its results. 

The food of tubercular children should consist of easily 
digested, nourishing things. Milk and eggs should form 



INFLUENZA 247 



a large part of the child^s diet^ but never should eggs be 
given to such an extent that the child becomes bilious. 
Well-cooked cereals are also excellent^, and bacon, broths, 
and, for older children, meat and vegetables in the usual 
amounts. 

Salt baths and sun baths are helpful, and some form 
of cod-liver oil or iron is usually prescribed. 

The tubercular child should not be considered hopeless. 
One should keep constantly at work and surprising re- 
sults may be met. 

Influenza 
(Orip) 

Causes. — Influenza, or grip, has been considered an in- 
fectious disease ever since the little microorganism causing 
it was isolated and seen under the microscope. Grip may 
be contracted by one child from another or from an adult ; 
therefore, when there is a case of grip in the house the 
children should carefully be kept out of the room. 

Symptoms. — In older children the symptoms of grip 
are much the same as in grown persons, but infants and 
young children often show different symptoms which make 
the diagnosis very difficult. The first symptoms may be 
shown at any time from a few hours to a week, or even 
longer after exposure. 

The disease may begin very abruptly, the child appear- 
ing very ill all at once ; or he may show signs of lassitude 
and irritability for several days before the acute symp- 
toms begin. 

One common form seen in young infants is Vailed the 



248 INFECTIOUS DISEASES OF CHILDHOOD 

febrile form. Here there is seen a high fever with very 
little cold in the head or cough; the baby appears very ill 
without apparent cause, and there may at times be a con- 
vulsion and often vomiting. If the baby is sufficiently ad- 
vanced in age he may complain of pains in his bones and a 
general aching all over his body. There is sometimes a 
bright red rash which resembles scarlet fever, thus making 
the diagnosis even more difficult. As a rule the high fever 
will last only a day or two, then subside, leaving the baby 
very weak, although in a few cases it may continue ir- 
regularly for several weeks. 

The most common form among older children is known 
as the catarrhal form. This begins suddenly, with, per- 
haps, a chill and very severe running at the nose and eyes, 
sneezing, coughing, headache, fever, pains in the joints 
and muscles, and a little later all the signs of bronchitis. 
This form also runs an irregular length of time from a 
few days to several weeks. There is no appetite and there 
is great prostration. 

Influenza, or grip, often affects the stomach or bowels, 
and is then called the gastroenteric form. There is a 
coated tongue, vomiting and diarrhea, the case much re- 
sembling one of typhoid fever. 

When influenza affects the brain we have many of the 
symptoms of meningitis — there is an influenza meningitis. 

Complications. — The complications of grip are many 
and often serious. Grip pneumonia is often met with and 
may terminate fatally. Abscess in the ear is very com- 
mon, and often causes great suffering until the drum of 
the ear is punctured or the abscess breaks of itself; it is 
one of the complications which should always be thought 



INFLUENZA 249 



of. It generally takes a child a long time to recover his 
strength after an attack of grip^ and there often results a 
form of malnutrition difficult to cope with. Tuberculosis 
sometimes develops after grip^ also enlarged glands. 

Treatment, — The treatment of grip must vary with the 
different forms of the disease and symptoms as they arise. 
The child should in all cases be kept in a room by him- 
self as quietly as possible and stay in bed as long as there 
is any fever^ and for two or three days afterward if there 
is much prostration. The digestive tract should be cleared 
early in the disease. I generally prefer small doses of 
calomel, often followed by citrate of magnesia; or castor 
oil may be given. 

The food should be very light and easy to digest, gruels 
and broths often being better borne than milk. Milk 
should be diluted with gruels or Vichy; kumyss and simi- 
lar preparations are also useful. It may be necessary to 
give stimulants if the child is very weak, but this must 
be left to the physician in each case. 

The high fever should be controlled by frequent sponge 
baths with alcohol in the water, and an icecap should be 
kept at the head. Drugs of the coal-tar variety are use- 
ful in some cases where the child is old enough to stand 
them. A nose spray of liquid albolene and a throat spray 
of a mild antiseptic solution are generally necessary. 
When the cough is severe or much bronchitis is present 
inhalations of steam and applications of mustard pastes to 
the chest are very helpful and may prevent pneumonia 
from developing. 

A tonic of iron or cod-liver oil should be taken when 
the child is convalescent. If possible a change of climate 



250 i:^FECTIOUS DISEASES OF CHILDHOOD 

should be given. I have found that children convalescent 
from grip generally respond better to a soft, mild climate 
where there are pine woods than when they are sent to 
convalesce by the sea. 

Disinfection, — Grip is such an infectious disease that 
it is only safe to the other members of the family to fumi- 
gate the sickroom and then clean it thoroughly at the close 
of the disease. Formalin candles are convenient to use 
and do not tarnish as sulphur does. 

Meningitis 

There are a number of different forms of meningitis — 
acute and chronic: tubercular meningitis, influenza meni- 
gitis, meningitis caused by a pus organism, meningitis 
caused by the pneumonia organism, meningitis caused by 
the colon bacillus, and the epidemic form caused by its own 
special microorganism. The first-mentioned forms are usu- 
ally parts of other diseases and will not be described here, 
as it is impossible for a mother to recognize them in any 
case. 

Acute Cerebrospinal Meningitis 

This disease is apt to occur in epidemics, but may ap- 
pear in single cases. It is a communicable disease, in- 
volving the spine as well as the brain. It has many dif- 
ferent forms and symptoms. The time from the exposure 
to the date when the first symptoms are seen, or period of 
incubation, is as yet unknown. 

Symptoms. — In the ordinary form the trouble will be- 
gin with a headache, chill, and vomiting; there may be 



ACUTE CEEEBROSPINAL MENINGITIS 251 

pains in back and legs; there is usually stiffness of the 
muscles^ and spasms; there may be restlessness^ delirium^ 
or coma. Paralysis of various muscles is common. The 
child usually lies with head drawn way back. There is 
generally trouble with the eyes^ it being difficult for the 
child to see^ and sight may be lost for a time at least. 
Deafness may also be present. Skin eruptions are often 
seen; the lips may be cracked and sore. The temperature 
is very variable; most often it is quite high at the begin- 
ning of the disease — 105° or 106° F. — and it then rises and 
falls in an irregular manner. The pulse and respiration 
may be irregular. Usually constipation is present. There 
is considerable loss in weight or wasting, the child being 
hard to feed. Bedsores are apt to develop. 

The outlook for recovery is always grave. In epidemic 
forms it is more doubtful than in cases which appear 
singly. Even when the' child recovers there is many times 
some grave trouble remaining, as deafness, blindness or 
even loss of speech. It is possible, however, to make a 
complete recovery. 

To be certain of the particular kind of meningitis the 
child has it is best to have some of the spinal fluid drawn 
off through a needle and examined in a laboratory. Treat- 
ment can then be better decided upon. 

Treatment. — The child should at once be put to bed in 
a cool, quiet room with the eyes protected from a bright 
glare of light. A bag filled with cracked ice should be 
kept pretty constantly on his head. The bowels should be 
kept open by enemas and mild laxatives, like milk of 
magnesia if the child can SAvallow well, or this may be given 
in his food. Careful attention should be paid to keeping 



252 INFECTIOUS DISEASES OF CHILDHOOD 

the mouth clean, washing it several times daily with 
boric acid solution or other mild disinfectant. 

After the sponge bath for cleansing purposes, it is well 
to rub a little alcohol down the spine and on the heels 
where bedsores are apt to develop. If the skin becomes 
the least bit broken it may be painted with flexible col- 
lodion and rings of cotton covered by gauze bandages 
should be slipped under the spine where it rests most heav- 
ily on the bed; it may also be slipped under the heels or 
under the head in the case of a baby with little hair. 

Feeding is difficult, and a liquid diet of milk, broths, 
thin gruels, buttermilk, kumyss or peptonized milk is 
about all that can be attempted while the disease is at 
its height. When the child does not swallow well, it is 
a good plan to try feeding with a feeding cup or a medi- 
cine dropper — if he has no teeth to bite the glass. At 
times all food is refused, and in that case a nurse must 
feed the child by means of a rubber tube attached to a 
glass funnel; this is called feeding hy gavage. Water and 
medicine for the bowels may also be given in this way if 
needed. The mother should not attempt to use the gavage 
unless specially taught by her doctor and it is impossible 
to get a nurse. As the child improves warm baths and 
massage may be helpful. There is a special serum now 
prepared that is injected into the spine and is very help- 
ful in many of the cases. 

Disinfection. — Duration of the disease is uncertain and 
relapses may occur. The average case lasts from three to 
six weeks. Other children should be removed from the 
house if possible, and the place thoroughly fumigated be- 
fore they are allowed to return. 



INFANTILE PARALYSIS 253 

Infantile Paralysis 
(Acute Poliomyelitis) 

Acute poliomyelitis, or infantile paralysis, is a com- 
municable disease which may occur in epidemics or in 
single cases. It is an inflammation of the spinal cord. 
The organism that causes it is so small that it cannot be 
seen even under a microscope, but experiments on mon- 
keys have proved that it is a living organism and may 
be destroyed by heat. The period of incubation is also 
uncertain; usually about ten days elapses from the time 
the child was exposed until he develops the first symptoms, 
but monkeys after exposure have been known to develop 
the disease in from four to thirty-four days. About 80 
per cent, of the cases seen occur in the first three years of 
life, but it is possible to occur at any time. The most 
likely time for epidemics of this disease to take place is 
in the warm months from July to October. 

Causes. — 'We are not certain exactly how this disease 
is carried from one child to another; some observers have 
thought the house fly might carry it. Some think it is 
taken into the system through the nose or mouth. 

Symptoms. — The usual onset of acute infantile paralysis 
is very sudden; high fever of 103° to 105° F. or possibly 
over, prostration, and often vomiting are most often noted. 
There may be diarrhea, but most often the bowels are con- 
stipated ; the urine may be retained. These symptoms may 
continue for several days and then marked muscular weak- 
ness is noticed, especially in the legs, and sometimes in the 
arms ; there may be complete paralysis of all four extremi- 



254 INFECTIOUS DISEASES OF CHILDHOOD 

tieS;, or only one member may be involved — each case dif- 
fers somewhat. In very mild cases no special symptom 
is noticed perhaps, but only a single restless night. In the 
morning the apparently healthy child will wake up para- 
lyzed. After the acute symptoms have subsided, there is 
usually a period of from one to three weeks in which no 
special change is seen; then gradual improvement is no- 
ticed, which continues for about three months. The paral- 
ysis remaining after this time is likely to be permanent. 
In the course of six or eight weeks the muscles shrink 
from lack of use, or atrophy, the limb afEected being 
smaller than the other and often blue and cold. 

The outlook for complete recovery is not good, but it is 
possible for some cases to become normal again. Death 
may occur but it is not likely to do so. What improve- 
ment will take place we cannot tell for some time; none 
can be expected after two years at least. 

Treatment — To prevent cases from developing we can 
do little but isolate all children in the acute stages and 
disinfect the discharges from the nose and throat of pa- 
tients who have the disease. Anyone taking care of a 
child with the disease should use an antiseptic nose and 
throat spray on herself. If it is impossible to send the 
other children away, their noses and throats should also 
be sprayed several times daily. In epidemic cases the 
patient should be quarantined at least a month. Treat- 
ment is very unsatisfactory. The child should be kept 
absolutely quiet in bed for one or two weeks at least ; some- 
times an icebag or a mustard plaster may be applied to 
the spine, but there is doubt as to its beneficial effects. 
During the fever only milk or fluid diet should be given. 



INFANTILE PARALYSIS 255 

Urotropin given early before the paralysis sets in may 
help to prevent the worst symptoms, but the physician in 
charge must decide about this. 

After the first symptoms of fever, etc., have disappeared 
massage of the affected parts must be begun and con- 
tinued for months at a time. A professional person must 
at first show the mother exactly how to massage the limb, 
but after a few lessons she may do this herself. Cocoa- 
nut oil or olive oil may be used on the fingers when mas- 
saging the limb. Alcohol should never be used for this 
purpose. In some cases electricity is advisable, but never 
should this be given without the advice of the physician 
in charge. The child should be taught to make an effort 
to use the paralyzed limb as much as possible, but the 
early use of braces, crutches, etc., is not to be advised, as 
they are relied upon too much. One should wait until all 
possible improvement has taken place and then these helps 
may be used if needed. The most nourishing foods, fresh 
country air, and quiet life with plenty of sleep — all these 
should be given the child, as they help to build up the 
general system. 



INDEX 



Abdominal pain, in onset of 

pneumonia, 190 
Abscess of ear, due to broncho- 
pneumonia, 188 
due to influenza, 248 
due to measles, 227 
in pneumonia, 192 
Acidosis, causes of, 112 
duration of, 112 
occurrence of, 112 
symptoms of, 112 
treatment and diet for, 113 
Adenitis of neck, differentiated 
from mumps, 216 
due to scarlet fever, 223 
Adenoids, bronchial asthma due 
to, 184 
chorea due to, 201 
chronic catarrh due to, 168 
convulsions due to, 198 
croup, catarrhal or spasmodic, 

due to, 173 
disturbed sleep due to, 205 
rhinitis due to, 165 
Albumin or egg water, recipe 

for, 31 
Alcohol sponge bath, 57 
Anemia, change of climate for, 
79 



Anemia, nosebleed with, 163 
Antitoxin, in diphtheria, 236 
Appetite, perverted. See Per- 
verted appetite 
Asthma, bronchial. See Bron- 
chial asthma 
change of climate for, 79 
due to nasal polypi, 170 
Atelectasis, hot bath and cold 

plunge for, 56 
Atomizer, albolene, for spray- 
ing of nose, 72 
throat, 73 
Atropin, solution of, for enure- 
sis, 45 
''Average'' baby, 13 
feeding of, 18, 19 

Bathing, in lobar pneumonia, 
193 

in marasmus, 147 

in rickets, 155 

of sick child, 6, 7 
Baths, alcohol sponge, 57 

bran, 55 

cold sponge or shower, 55 

cold tub, 57 

hot, 53 

hot air or vapor, 53 



257 



258 



INDEX 



Baths, for medicinal purposes, 


Bottle-fed babies, food formu- 


52 


las for. See Food for- 


mustard, 54 


mulas 


mustard foot, 58 


Bottles, for feeding, care of, 


premature infant's, 83 


17 


salt water, 55 


Bow legs, in rickets, treatment 


soda, 56 


of, 157 


starch, 57 


Bowel movements. See Stools 


tepid, 55 


enemata for. See Enemata 


Bedsores, in marasmus, 147 


regulation of, 159, 160 


Bed-wetting. See Enuresis 


Bowels, irrigation of. See Ir- 


Beef juice, cold process, recipe 


rigation of bowels 


for, 30 


Bran gems, recipe for, 34 


warm process, recipe for, 31 


Breathing, character of, to be 


Beef pulp, scraped, recipe for. 


observed in sick child, 


33 


37 


Benzoin, use of, in inhalations. 


difficult, in bronchial asthma, 


77 


184 


Bicarbonate of soda, in infant 


in bronchopneumonia, 186, 


feeding, 19 


187 


Bilious attacks, location of, 140 


treatment for, 189 


symptoms of, 140 


in diphtheria, 235 


treatment of, by food, 141 


in laryngitis, acute catarrh- 


by medicine, 141 


al, 178 


in children subject to, 141 


loud, sawing, in membranous 


Blanc mange, Irish moss, recipe 


croup, 176 


for, 33 


quicker than normal, in bron- 


Blinking of eyes, 202 


chitis, 179 


Blood in nasal discharge, indi- 


rapid, in pneumonia, 191 


cating diphtheria, 166, 


See also Eespiration 


235 


Breathing apparatus, inhala- 


Bones, condition of, in rickets. 


tions in treatment of 


152 


affections of, 74 


tuberculosis of, 245 


^^Breck Feeder,^' for prema- 


Boric acid, in vaginal douches, 


ture or delicate babies, 


70 


87 



INDEX 



259 



Bronchial asthma, causes of, 
184 
occurrence of, 184 
symptoms of, 184 
treatment of, by nose and 
throat specialist, 185 
diet, 185 
drugs, 185 

inhalations and mustard 
paste, 185 
Bronchial tubes and lungs, dis- 
eases of, bronchial 
asthma, 184 
bronchitis, acute, 178 
bronchopneumonia, 186 
lobar pneumonia, 190 
Bronchitis, acute, causes of, 179 
definition and occurrence 

of, 178 
symptoms of, in mild forms, 
179 
in severe forms, 179 
treatment of, against fur- 
ther attacks, 180 
diet, 183 
drugs, 183 
general, 181 
inhalations, 74, 182 
mustard paste, 83, 182 
to loosen cough, 183 
bronchopneumonia d i s t i n - 

guished from, 188 
diseases associated with, 179 
with measles, 227 
Bronchopneumonia, causes of, 
186 



Bronchopneumonia, complica- 
tions in, earache with 
resulting abscess of 
ear, 188 
empyema, 188 
differentiated from bronchi- 
tis, 188 
duration of, 187 
symptoms of, cough and diffi- 
cult breathing, 187 
general, 186 
in secondary cases, 186 
treatment of, castor oil or 
calomel, 188 
change of climate, 189 
diet, 189 
general, 189 

inhalations and mustard 
paste, 188, 189 
with diphtheria, 237 
with measles, 227 
Broth, clam, recipe for, 30 
Broths, recipes for, 30 
Buttermilk, recipe for, 28 
use of, 28 

Calomel, correct dose of, 48, 
122 
for bilious attacks, 141 
for convulsions, 200 
for tonsillitis, 172 
importance of physician 's 

prescription for, 48 
in lobar pneumonia, 193 
Canker sores. See Stomatitis, 
aphthous 



260 



INDEX 



Castor oil, correct dose of, 47, 


Chickenpox, period of incuba- 


122 


tion of, 213 


for convulsions, 199 


symptom^ of, eruption, 217^ 


method of giving, 47 


218 


in rhinitis, acute, 167 


general, 218 


Catarrh, acute. See Ehinitis, 


onset, 217 


acute 


treatment of, 218 


chronic, causes of, 168 


Chill, in malaria, 242 


adenoids and enlarged 


Chilling, irrigation of bowels 


tonsils, 168 


for, 67 


congenital defects, 171 


mustard foot bath for, 58 


foreign bodies in nose. 


Cholera infantum, 124 


170 


causes of, 124 


nasal polypi, 170 


symptoms of, 124 


deafness caused by, 169 


treatment of, 125 


symptoms of, 168, 169 


Chorea, association of, with 


treatment of, its importance, 


rheumatism, 161, 201 


171 


causes of, 201 


removal of adenoids or 


definition of, 200 


enlarged tonsils, 169 


occurrence of, 201 


spraying, 170 


symptoms of, 201 


Catarrh of stomach, stomach 


treatment of, 201 


washing for, 69 


Circulation, poor, massage for, 


See also, Gastritis, chronic 


78 


Catheter, for irrigation of bow- 


Circumcision, for masturbation, 


els, 66, 67 


209 


Cereal gruel, as diluent in in- 


Clam broth, recipe for, 30 


fant feeding, 18, 20 


Climate, change of, choice of, 80 


Cereal gruels, recipes for, 25, 26 


diseases indicating, 79 


Cereal jellies, recipe for, 26 


Cold or fever sores. See Herpes 


Chamber, use of, in infant 


Cold or ice pack, 58, 59 


training, 159, 160 


^ ' Colds, '^ mustard foot bath 


Chickenpox, causes of, 217 


for, 58 


contagion of, 217 


See also Ehinitis, acute 


definition of, 217 


Colic, 133 


disinfection of, 218 


causes of, 134 



INDEX 



261 



Colic, due to constipation, 130 
symptoms of, 134 
treatment of actual attack 

of, 135 
treatment of cause of, 135, 
136 
Collapse or shock, hot baths for, 
53 
hot pack for, 60 
mustard bath for, 54 
mustard pack for, 59 
Congestion, local, ice cap in re- 
lieving, 60 
Constipation, due to bilious at- 
tacks, 140 
in children with inherited 
rheumatic tendency, 
159, 160 
chronic, causes of, 130 
nature of, 130 
symptoms of, 130 
treatment of, in bottle-fed 
babies, 132 
in breast-fed babies, 131 
in older children, 133 
colic due to, 134 
in gastritis, chronic, 111 
massage for, 77 
nervous headache due to, 203 
with occasional attacks of 
diarrhea, in intestinal 
indigestion, 127 
in pneumonia, 191 
in premature infants, 90 
Contagious diseases. See Infec- 
tious diseases 
18 



Convulsions, causes of, 197 
occurrence of, 197 
in onset of pneumonia, 190 
in pneumonia, 192 
symptoms of, 198 
treatment of, bowels, 199 
diet, 200 
drugs, 200 
general, 199 
hot bath, 53 
hot pack, 60 

ice pack and mustard wa- 
ter, 199 
mustard bath, 54 
mustard pack, 59 
by removal of cause, 200 
in whooping-cough, 229 
Cough, dry, hacking, in bron- 
chopneumonia, 187 
in pneumonia, 191 
hoarse, dry, barking, in acute 
catarrhal laryngitis, 
178 
hollow, barking, of croup, 174 
incessant, tight, in bronchitis, 

179, 183 
in measles, 226 
in rhinitis, treatment of, 168 
slight, with wheezing, in 
bronchial asthma, 185 
in whooping-cough, 228 
Counterirritants, 63 
Croup, catarrhal or spasmodic, 
causes of, 173 
definition of, 173 
symptoms of, 173 



262 



INDEX 



Croup, catarrhal or spasmodic, 


Diarrhea, simple or summer. 


treatment of, diet, 175 


117 


drugs, 175 


causes of, 117 


general, for children sub- 


prevention of, 118, 119 


ject to, 176 


symptoms of, 118 


inhalations, 74, 175 


treatment of, change of 


to relax spasm of larynx, 


climate, 79 


175 


to control fever, 124 


inducing vomiting, 174 


diet, 120, 121 


preceding diphtheria, 235 


gene^-al, 120 


membranous, causes of, 176 


medicine, 122, 123 


symptoms of, 176 


in whooping-cough, 229 


treatment of, 177 


Diet, of nursing mother, for 


Croup kettle for inhalations, 76 


constipated infants, 


Croupous pneumonia. See 


131 


Pneumonia, lobar 


See also Feeding 


Cry, in colic, 134 


Digestion, diseases of, of mouth. 


nature of, 38 


herpes — fever or cold 


of premature infants, 90 


sores, 92 




little ulcers, 92 


Deafness, due to chronic ca- 


stomatitis, 95 


tarrh, 169 


thrush or sprue, 98 


due to mumps, 216 


of pharynx, pharyngitis. 


Deformities, of rickets, 152, 153 


acute, or sore throat, 


treatment of, 156, 157 


99 


Delicate infants. See Prema- 


of stomach and intestines. 


ture infants 


abnormal stools, 115 


Delirium, in bronchopneumonia. 


acidosis — recurrent or 


192 


cyclic vomiting, 112 


Dextrinized gruels, as diluent 


bilious attacks, 140 


in infant feeding, 27 


cholera infantum, 124 


recipe for, 26 


colic, 133 


Diarrhea, in bronchopneumonia. 


constipation, chronic. 


187 


130 


in cholera infantum, 124 


diarrhea, simple or sum- 


in measles, 227 


mer, 117 



INDEX 



263 



Digestion, diseases of, of stom- 


Discharge from nose, blood in, 


ach and intestines, gas- 


166, 235 


tritis, chronic, 106 


in chronic catarrh, 169 


intestinal indigestion. 


in croup, 173 


chronic, 126 


due to foreign bodies, 170 


intestinal parasites or 


of mucus mixed with blood, 


worms, 137 


indicating diphtheria, 


vomiting or acute gastric 


166, 235 


indigestion, 103 


Discharge from vulva, white, 


of teeth, painful teething, 94 


due to threadworms, 


of tongue, red patches, 93 


139 


ulcers, 93 


Discipline, in use of chamber, 


Diluents in infant feeding. 


159, 160 


boiled water, 20, 22 


of sick child, 12 


cereal gruels, 18, 20 


in infectious diseases. See 


dextrinized gruels, 26, 27 


each infectious disease 


Diphtheria, causes of, 234 


Disinfection, of patient and 


complications in, 237 


nurse, 6 


contagion of, 234 


of sickroom, 2 


disinfection of, 237 


See also Fumigation 


laryngeal, 235 


Douches, nasal, 70 


period of incubation of, 212, 


throat and mouth, 72 


234 


vaginal, 70 


symptoms of, discharge from 


Dry cups, 64 


nose of mucus mixed 




with blood, 235 


Ear, abscess of. See Abscess of 


general, 235 


ear 


membrane, 234, 235 


inflammation of, due to scar- 


treatment of, antitoxin, 236 


let fever, 223 


immunizing dose to rest of 


irrigation of, 74 


family, 236, 237 


Earache, with resulting abscess 


bowels, 237 


of ear, due to broncho- 


diet, 237 


pneumonia, ISS 


general, 237 


Egg, coddled, recipe for, 32 


precautionary, 235, 236 


Egg and milk idiosyncrasy, 35, 


throat culture, 236 


36 



264 



INDEX 



^gg nog, recipe for, 32 


Eruption, in typhoid fever, 238 


Egg or albumin water, recipe 


See also Eash 


for, 31 


Expression, observation of, in 


Electricity, caution against use 


care of child, 37 


of, without doctor 's or- 


Eyestrain, nervous headache due 


der, 79 


to, 203 


use of, in forms of paralysis, 


Eyes, inflammation of, due to 


79 


measles, 227 


Emaciation, in marasmus, 146 


irrigation of, 73 


in tuberculosis, 245 




Empyema, due to bronchopneu- 


Feeding, in acute cerebrospinal 


monia, 188 


meningitis, 252 


Enemata, amount of fluid ac- 


in bronchial asthma, 185 


cording to age, 65 


in bronchitis, 183 


caution against over-use of, 


in bronchopneumonia, 189 


65 


care and appurtenances of, 


in convulsions, 199 


12, 13 


olive oil, 66 


care of bottles and nipples 


syringe for, 66 


for, 17, 18 


temperature of, 66 


in colicky infants, 136 


Enlarged tonsils, asthma, bron- 


after convulsions, 200 


chial, due to, 184 


in croup, catarrhal or spas- 


chorea due to, 201 


modic, 175 


chronic catarrh due to, 168 


devices for keeping warm at 


croup, catarrhal or spasmodic, 


night, 17 


due to, 173 


in diphtheria, 237 


disturbed sleep due to, 205 


formulas for. See Food for- 


rhinitis due to, 165 


mulas for bottle-fed 


Enuresis or bed-wetting, causes 


babies 


of, 44 


in gastric indigestion, 105, 


symptoms of, 44 


106 


treatment of, 45 


in German measles, 233 


by atropin, 45 


of infants with hereditary 


by diet, 45 


rheumatic tendencies, 


by strychnin, 46 


158, 159 


Eruption, in chickenpox, 217 


in influenza, 249 



INDEX 



265 



Feeding, intervals of, and quan- 


Fever, nervous children with. 


tities allowed, for 


cold or ice pack for, 


babies during first 


58, 59 


year, 14 


in pneumonia, 191 


in intestinal indigestion, 127, 


reduction of, by alcohol 


128 


sponge bath, 57 


in lobar pneumonia, 193 


in bronchitis, 183 


in marasmus, 149 


in bronchopneumonia, 188, 


milk in, quality of, 15 


189 


treatment of, 16 


by cold tub bath, 57 


in mumps, 215 


by ice cap, 60 


of premature infants, 8Q 


by irrigation of bowels, 67 


preparation for, 16 


in lobar pneumonia, 193, 


recipes for food. See Reci- 


194 


pes 


in mumps, 215 


in scarlet fever, 222 


in typhoid fever, 240 


temperature of, 16, 17 


in scarlet fever, 221, 222 


in tonsillitis, follicular, 172 


in typhoid fever, 238 


in tuberculosis, 246 


See also Temperature 


in typhoid fever, 240 


Fever or cold sores. See Herpes 


utensils for preparation of. 


Flaxseed meal poultices, 65 


14, 15 


Flour ball, recipe for, 27 


in top milk formulas, 21 


Food formulas for bottle-fed 


vomiting after, 104 


babies, bicarbonate of 


in whooping-cough, 229 


soda in, 19 


See also Diet 


dextrinized gruels in, 26, 27 


Fever, due to constipation, 


diluents in, boiled water, 20, 


130 


22 


effect of, on urine, 41 


cereal gruel, 18, 20 


in German measles, 232 


general considerations, IS, 19 


in infantile paralysis, 253 


goat^s milk in, 19 


in influenza, 249 


lime water in, 19 


irregular, in bronchopneu- 


protein in, non-digestion of, 


monia, 187 


25 


in malaria, 242 


sugar, malt, milk or cane in, 


in measles, 225 


19 



266 



INDEX 



Pood formulas for bottle-fed 


Gastric indigestion, acute. See 


babies, top milk, 21-25 


Vomiting 


whole milk in, 18 


Gastritis, chronic, in infants. 


whole or plain milk, 20 


106 


See also Eecipes 


causes of, 107 


Pood formulas for premature in- 


constipation in, 111 


fants, modified milk, 88 


food during, 109, 110 


Food recipes. See Recipes 


treatment of, 108 


Poods, patent, scurvy due to, 


in older children, food dur- 


143 


ing, 112 


Poreign bodies in nose, catar- 


treatment of, 111 


rhal discharge caused 


symptoms of, 107 


by, 170 


stomach washing for, 69 


treatment of, 164 


Gavage, in acute cerebrospinal 


Poreskin, adherent. See Phi- 


meningitis, 252 


mosis 


for premature infants, 89 


Poul breath, due to catarrh. 


Geographical tongue, 93 


chronic, 168 


German measles, causes of, 231 


Pumigation, by formaldehyd. 


communication of, 231 


Holt's method, 4 


complications in, 232 


by formalin candles, 5 


disinfection of, 234 


of sickroom after infectious 


duration of, 234 


diseases. See each in- 


occurrence of, 231 


fectious disease. 


period of incubation of, 212, 


method of, 3 


231 


after milder infectious dis- 


symptoms of, fever, 232 


eases, 5 


general, 231 


by sulphur, 3 


rash, 231 


views of New York Depart- 


swelling of glands at back 


ment of Health on, in 


and side of neck, 232 


private homes, 5 


treatment of, bowels, 233 




diet, 233 


Gargle, boric acid, 101 


isolation, 232 


borolyptol, 101 


mouth, nose and throat, 


Gastric catarrh. See Gastritis, 


233 


chronic 


sponge bath, 233 



INDEX 



267 



Gluten suppositories, 69 


Heart disease, due to diph- 


Glycerin suppositories, 69 


theria, 237 


Gonorrhea, vaginal douches for, 


Hemorrhages, under skin, in 


70 


scurvy, 144 


Graham mush, recipe for, 35 


in whooping-cough, 229 


Grimaces, 202 


Herpes, causes of, 92 


Grippe, change of climate for, 


treatment of, 92 


79 


Hiccough, causes of, 202 


See also Influenza 


treatment of, 202 


Growing pains, in children with 


Hip- joint disease, 245 


inherited rheumatic 


Hospitalism. See Marasmus 


tendency, 161 


Hot fomentations or stupes, 62 


Gruels, cereal. See Cereal 


Hot water bag, in care of pre- 


gruels 


mature infants, 85 


dextrinized, recipe for, 26 


purpose and use of, 61 


Gums, condition of, in scurvy, 




144 


Ice cap, purpose and use of, 60, 


Gymnastic exercises, for consti- 


61 


pated older children, 


Ice cream, vanilla, recipe for. 


133 


34 




Ice pack, 58, 59 


Habit spasms, 202 


in lobar pneumonia, 194 


treatment of, 202 


Idiosyncrasies, milk and eggy 


Habits, bad, of childhood, mas- 


35, 36 


turbation, 208 


Incontinence of urine. See Enu- 


nail-biting, 207 


resis 


perverted appetite or 


Incubators, for premature in- 


dirt-eating, 207 


fants, 85 


thumb-sucking, 206 


Indigestion, acute gastric. See 


tongue- sucking, 207 


Vomiting 


Hay fever, as form of asthma, 


use of buttermilk in, 2S 


184 


use of casein or protein milk 


change of climate for, 79, 81 


for, 28, 29 


Headache, nervous, causes of. 


chronic intestinal. See Intes- 


203 


tinal indigestion, 


treatment of, 203 


chronic 



268 



INDEX 



Indigestion, colic due to, 


133 


Influenza, bronchopneumonia 


fat, use of Keller 's malt 


50up 


developed from, 186 


in, 29 




causes of, 247 


due to teething, 94, 95 




cnange of climate for, 79 


treatment, at first sign of 


120 


complications in, abscess of 


Infantile paralysis, causes 


of, 


ear, 248 


253 




malnutrition and tubercu- 


definition and occurrence 


of, 


losis, 249 


253 




pneumonia, 248 


period of incubation of, 253 


disinfection in, 250 


symptoms of, 253, 254 




period of incubation of, 


treatment of, 254, 255 




213 


Infectious diseases, 211 




symptoms of, in catarrhal 


chickenpox, 217 




form, 248 


chorea due to, 201 




in febrile form, 248 


definition of, 211 




in gastroenteric form, 248 


diphtheria, 234 




onset, 247 


German measles, 231 




treatment of, 249 


germs of, 211 




Influenza meningitis, 248 


infantile paralysis, 253 




Inhalations, in acute catarrhal 


influenza, 247 




laryngitis, 178 


initial symptoms of, convul- 


benzoin for, 77 


sions, 197 




in bronchial asthma, 185 


nervous headache, 203 




in bronchitis, acute, 182 


vom.iting, 106 




in bronchopneumonia, 188, 


malaria, 241 




189 


measles, 224 




in croup, 175 


meningitis, 250 




croup kettle for,<i76 


mumps, 213 




method of giving, 75 


period of incubation of. 


212, 


tent for, 75 


213 




length of time under, 77 


scarlet fever, 221 




use of, 74 


tuberculosis, 244 




Intestinal disease, irrigation of 


typhoid fever, 237 




bowels and salt solu- 


vaccination, 219 




tion in intestines for^ 


whooping-cough, 227 




68 



INDEX 



269 



Intestinal indigestion, chronic, 
causes of, 126 
occurrence of, 126 
symptoms of, 126, 127 
treatment of, 127 

in older children, 128 
medical, 129 
urine in, 130 
nervous headache due to, 
203 
Intestinal parasites, causes of, 
137 
convulsions due to, 198 
occurrence of, 137 
roundworm, description of, 
138 
symptoms of, 138 
treatment of, 138 
tapeworm, description of, 137 
symptoms of, 137 
treatment of, 137 
threadworms or pinworms, 
description and site of, 
139 
symptoms of, 139 
treatment of, 140 
varieties of, 137 
Irish moss blanc mange, recipe 

for, 33 
Irrigation of bowels, catheter 
for, 66 
height to insert, 66 
type of, 67 
indication for stopping of, 6S 
leaving of salt sohition in in- 
testines after, 6S 



Irrigation of bowels, procedure 
in, 67 
quantity of water, 67 
temperature of water in, 67 
Irrigation of ear, 74 
Irrigation of eye, 73 
Itching of anus and surround- 
ing parts, due to 
threadworms, 139 

Jellies, cereal, recipe for, 26 
orange, recipe for, 33, 34 
prune, recipe for, 34 
wine, recipe for, 34 

Jerking of hands or legs, 202 

Junket, recipe for, 34 

Keller's malt soup, recipe for, 

29 
Kidney disease, due to diph- 
theria, 237 
hot air or vapor baths for, 53 
due to scarlet fever, 223 

Laryngitis, acute catarrhal, 
causes of, 177 
symptoms of, 177 
treatment of, 178 
inhalations in treatment of, 

74 
with measles, 227 
membranous. See Croup, 
membranous 
LarjTix, diseases of, 173 

croup, catarrhal or spas- 
modic, 173 



270 



INDEX 



Larynx, diseases of, laryngitis, 
acute catarrhal, 177 
membranous, or mem- 
branous croup, 176 
Laxative foods. See Recipes, 

laxative 
Laxatives, calomel, 48 
castor oil, 47 
milk of magnesia, 47 
Leukorrhea, vaginal douches 

for, 70 
Lime water, in infant feeding, 
19 
recipe for, 32 
Listlessness, due to constipa- 
tion, 131 

Malaria, causes of, 241 
chronic, 242 
occurrence of, 241 
symptoms of, in older chil- 
dren, 241, 242 
in yoimg babies, 241, 
242 
treatment of, blood examina- 
tion, 244 
general, 242 
quinin, 242, 243 
Malnutrition, change of climate 
for, 79 
diseases of, marasmus, 145 
rickets, 151 
scurvy, 143 
due to influenza, 249 
massage for, 78 
See also Marasmus 



Malt soup, Keller's, recipe for, 

29 
Marasmus, bedsores in, 147 
causes of, 145 
definition and occurrence of, 

145 
symptoms of, 146 
thrush associated with, 148 
treatment of, by bathing, 147 
bowels, 148, 149 
change of climate, 147 
by drugs, 150 
food, 149 
by fresh air, 148 
to prevent bedsores, 147 
to prevent thrush, 148 
type of tuberculosis resem- 
bling, 245 
Marasmus babies, Keller's malt 
soup for, 29, 30 
treatment of, by bathing, 147 

78 
for inherited syphilis, with 
mercurial ointment, 78 
method of, 78 
for older children, 78 
for paralysis, 78 
for poor circulation or nutri- 
tion, 78 
use of, 77 
Masturbation, age at which 
practiced, 208 
causes of, 208 
symptoms of, 208 
due to threadworms, 139 
treatment of, 209 



INDEX 



271 



Measles, causes of, 224 
communication of, 224 
complications in, 227 
bronchitis, 179, 227 
bronchopneumonia, 186, 227 
contagion of, 224 
disinfection of, 227 
period of incubation of, 212, 

224 
symptoms of, cough, 226 
Koplik^s spots, 226 
odor, 225 
onset, 225 
rash, 225 
treatment of, 226, 227 
Meconium, 114 

Medicine, administration of, hj 
dropper, 51 
by rectum, 51 
administration of irons and 
acids by glass tube, 51 
administration of pills, tab- 
lets, capsules, by crush- 
ing, 51 
exactitude in amount and 

time of dose, 49, 50 
sanitary care of, 50 
time of dose of, 51 
Medicines, calomel, 48 
patent, 49 

safely given without doctor's 
prescription, castor oil, 
47 
milk of magnesia, 4 
Membranous croup. See Croup, 
membranous 



Membranous laryngitis. See 

Croup, membranous 
Meningitis, acute cerebrospinal, 
disinfection of, 252 
nature of, 250 
symptoms of, 251 

onset, 250 
treatment of, diet, 252 
general, 251 
forms of, 250 
influenza, 248 
tubercular, 245 
Milk, casein or protein, recipe 
for, 29 
use of, 28 
''certified,'^ 15 
in infant feeding, goat's, 19 
quality of, 15 
top, 21 

formulas for, 22 
treatment of, 16 
whole, 18 

formulas for, 20 
'lactic acid,'' 28 
pasteurized, recipe for, 27 

scurvy due to, 143 
peptonized, recipe for, 27 
sterilized, scurvy due to, 143 
Milk and egg idiosyncrasy, 35, 

36^ 
Milk of magnesia, correct dose 
of, 48 
method of giving, 47 
IMilk punch, recipe for, 32 
Mouth, diseases of, herpes — fe- 
ver or cold sores, 92 



272 



INDEX 



Mouth, diseases of, little ulcers, 

92 
Mouthwash, formula for, in 

stomatitis, 98 
Mumps, causes of, 213 
complications in, 216 
contagion of, 213, 214 
definition and occurrence of, 

213 
differentiated from adenitis 
of neck or simple swell- 
ing of lymphatic gland, 
216 
disinfection after, 216 
period of incubation of, 212, 

214 
symptoms of, diminished se- 
cretion of saliva, 214 
general, 214 
pain in moving jaws, 214, 

215 
swelling, 214 
treatment of, 215 
Mustard, value of, 64 
Mustard bath, 54 
Mustard foot bath, 58 
Mustard pack, 59 
Mustard paste, 63 

in bronchial asthma, 185 

in bronchitis, 182 

in bronchopneumonia, 188, 

189 
in lobar pneumonia, 195 

Nail-biting habit, 207 

Nasal cavities, diseases of, for- 



eign bodies in nose, 
164 
nosebleed, 163 
rhinitis, acute, catarrh or 
' ^ colds, ^' 165 
Nasal douches, 71 
Nasal polypi, asthma due to, 
170 
chronic catarrh due to, 170 
Nervous condition, observation 
of, in care of child, 37 
Nervous headache. See Head- 
ache, nervous 
Nervous symptoms, with high 
temperature, cold or ice 
pack for, 58, 59 
in intestinal indigestion, 127 
in pneumonia, 192 
in teething, 95 
tepid bath for, 55 
due to threadworms, 139 
in typhoid fever, 239 
Nervous system, bad habits of 
childhood, masturba- 
tion, 208 
nail-biting, 207 
perverted appetite or dirt- 
eating, 207 
thumb- sucking, 206 
tongue- sucking, 207 
diseases of, 197 
chorea, 200 
convulsions, 197 
disorders of speech, 203 
habit spasms, 202 
hiccough, 202 



INDEX 



273 



Nervous system, diseases of, 


Paralysis, due to diphtheria, 


nervous headache, 203 


237 


night terrors of childhood, 


electricity for, 79 


205 


massage for, 78 


sleeplessness or disturbed 


scurvy mistaken for, 144 


sleep, 204 


Parasites, intestinal. See Intes- 


Night terrors of childhood, 205 


tinal parasites 


Nipples, rubber, care of, 17, 


Patent foods, scurvy due to. 


18 


143 


Nose and throat, spraying of, 


Patent medicines,' 49 


72, 73 


Perspiration, profuse, salt water 


Nosebleed, causes of, 163 


baths for, 55 


duration of, 163 


Perverted appetite or dirt-eat- 


occurrence of, 163 


ing habit, causes of, 


symptoms of, 163 


208 


treatment of, 164 


symptoms of, 207 


Nursing mother, diet of, for 


treatment of, 208 


constipated infants. 


Pharyngitis, appearance of 


131 


white spots in, 101 


Nutrition, faulty. See Malnu- 


causes of, 99 


trition 


diet in, 102 


general, in care of child, 37 


duration of, 100 




liability of, to precede or ac- 


Olive oil enema, QQ 


company contagious 


Orange jelly, recipe for, 33, 34 


diseases, 100 


Otitis, due to scarlet fever, 223 


with measles, 227 


Overfeeding, vomiting due to, 


symptoms of, 100 


103 


treatment of, 100 


Overwork, chorea due to, 201 


Pharynx, diseases of, pharyn- 




gitis, acute, or sore 


Pacifier, bad effects of use of, 


throat, 99 


206 


Phimosis, chorea due to, 201 


Packs, cold or ice, 58, 59 


convulsions due to, 198 


hot, 60 


Pinworms. See Intestinal Para- 


mustard, 59 


sites 


use of, 58 


Pleurisy, with pneuiuouia, 192 



274 



INDEX 



Pneumonia, croupous. See Pneu- 


Premature infants, administra- 


monia, lobar 


tion of plenty of water 


with influenza, 248 


to, 89 


inhalations in treatment of, 


airing of, 91 


74 


bed for, 85 


lobar, causes of, 190 


care of, 82 


complications in, abscess of 


clothing of, 83, 84 


ear, 192 


constipation of, 90 


pleurisy, 192 


cry of, 90 


occurrence of, 190 


daily clearing out of intes- 


symptoms of, delirium and 


tines of, 90 


nervous symptoms, 192 


definition of, 82 


fever, 191 


first bath of, 83 


general, 191 


hot water bags in care of, 85 


onset, 190 


incubators for, 85 


treatment of, bowels, 193 


nourishment of, administered 


diet, 193 


by dropper or ''Breck 


drugs, 195 


Feeder,'' 87 


fresh air, 192, 193 


amount given, 88 


ice pack, 194 


breast milk, ^Q 


stimulants, 195 


by gavage, 89 


sponge baths, 193 


modified milk, 88 


mustard paste for, 63 


formula for, 88 


with whooping-cough, 229 


through skin, by oil and co- 


Pneumonic fever. See Pneu- 


coa butter baths, 89, 90 


monia, lobar 


uniform warmth of milk 


Poisonous substances, stomach 


administered, 88 


washing after swallow- 


uniform warmth for, 83 


ing of, 69 


weighing of, 90 


Poliomyelitis, acute. See infan- 


Prickly heat, soda baths for, 56 


tile paralysis 


st-arch baths for, 57 


Position, as point to be watched 


Prostration, irrigation of intes- 


in care of child, 38 


tines and salt solution 


Pott's disease, 245 


in intestines for, 68 


Poultices, flaxseed meal, Q^ 


Protein in infant feeding, non- 


inadvisability of, 64 


digestion of, 25 



INDEX 



275 



Prune jellj, recipe for, 34 


Eecipes, graham mush, 35 


Pulse, normal, 39 


prune jelly, 34 


to take, 39 


lime water, 32 




milk punch, 32 


Quinin, for malaria, 242, 243 


orange jelly, 33 




pasteurized milk, 27 


'^Eachitic rosary,'' 152 


peptonized milk, 27 


Eash, of German measles, 231 


soups, Keller's malt, 29 


of measles, 225 


soups or purees, cream of cel- 


of scarlet fever, 221 


ery and other vegeta- 


See also Eruption 


bles, 31 


Eashes, in children with inher- 


potato, 31 


ited rheumatic tenden- 


whey, 28 


cy, 161 


wine jelly, 34 


Eecipes, albumin or egg water. 


Eectum, adm-inistration of medi- 


31 


cine by, 51 


barley and oatmeal gruels 


Eed patches on tongue, cause 


or waters from the 


and treatment of, 93 


flour, 25 


Eespiration, to count, 39 


beef juice, cold process, 30 


normal, according to Holt, 40 


beef juice, warm process, 31 


See also Breathing 


beef pulp, scraped, 33 


Eespiratory system, diseases of. 


broths, 30 


of bronchial tubes and 


buttermilk, 28 


lungs, bronchial asth- 


casein or protein milk, 28, 29 


ma, 184 


cereal jellies, 26 


bronchitis, acute, 178 


clam broth, 30 


bronchopneumonia, 186 


coddled egg, 32 


lobar pneumonia, 190 


dextrinized gruels, 26 


of larynx, croup, catarrhal or 


egg nog, 32 


spasmodic, 173 


farina gruel, 26 


laryngitis, acute ca- 


flour ball, 27 


tarrhal, 177 


ice cream, vanilla, 34 


membranous, or mem- 


Irish moss blanc mange, 33 


branous croup, 176 


junket, 34 


of nasal cavities, foreign 


laxative, bran gems, 34 


bodies in nose, 164 



276 



IISTDEX 



Bespiratory system, diseases of, 
of nasal cavities, nose- 
bleed, 163 
rhinitis, acute, catarrh 
or '' colds, '^ 165 
of throat, catarrh, chronic, 
adenoids and enlarged 
tonsils, 168 
tonsillitis, follicular, 171 
Bheumatic tendency, chorea or 
St. Vitus ^s dance with, 
161 
constipation with, 159, 160 
growing pains with, 161 
importance of precautionary 
measures against, 158, 
162 
rashes with, 161 
sore throat with, 160 
stiff neck with, 161 
tonsillitis, follicular, with, 171 
Eheumatism, 157 

association of, with chorea, 

201 
causes of, 157, 158 
preventive measures against, 
by food, 158, 159 
general, 158 

in bowels and kidneys, 159 
water drinking, 159 
scurvy mistaken for, 144 
Rhinitis, acute, 165 

blood in discharge of, 166 
causes of, 165 
contagion of, 165 
duration of, 166 



Rhinitis, symptoms of, 166 

treatment of, bowels, 167 
cleaning or spraying of 

nose, 168 
coughs, 168 
feeding, 167 
general, 167 
medicine, 167 
Rhubarb, spiced syrup of, sched- 
ule for dose of, 123 
Rickets, causes of, 151 
change of climate for, 79 
definition and occurrence of, 

151 
duration of deformities of, 154 
symptoms of, abdominal, 153 
in bones, 152 
general, 151, 152 
in mucous membranes, 153 
treatment of, bathing, 155 
in daily routine, 155 
for deformities, 156, 157 
food, 154 

in incipient stage, 154 
medicines, 155 
Rose colds, as form of asthma, 

184 
Roundworm. See Intestinal 

parasites 
Rubella. See German measles 

St. Vitus 's dance. See Chorea 
Santonin, for roundworms, sche- 
dule for dose of, 138 
Scarlet fever, causes of, 221 
communication of, 221 



INDEX 



277 



Scarlet fever, complications in, 


Sick child, administration of 


adenitis, 223 


medicine to, by drop- 


nephritis, 223 


per, 51 


otitis, 223 


exactitude in amount and 


swelling of joints, 223 


time of dose, 49, 50 


confinement of child with, 221 


by glass tube, for irons and 


disinfection of, 224 


acids, 51 


period of incubation of, 212 


milk of magnesia, 47 


symptoms of, appearance of 


by rectum, 51 


tongue and throat, 221 


sanitary care of bottle or 


fever, 222 


glass, 50 


general, 221 


time of dose, 51 


rash, 221 


amusements for, 10, 11 


treatment of, bowels, 222 


bathing of, 6, 7 


diet, 222 


* care of, points to be watched 


isolation, 222 


for, 37, 38 


nose and throat, 223 


pulse in, 39 


sponge baths, 222 


respiration in, 39 


urine, 223 


temperature in, 40 


Scurvy, 103 


urine in, 41 


causes of, 143 


*' vital signs'' in, 38 


mistaken for rheumatism or 


clothing for, 8, 9 


paralysis, 144 


discipline of, 12 


symptoms of, 143, 144 


disinfection of, 6 


treatment of, 144, 145 


feeding of. See Feeding 


Self-abuse. See Masturbation 


methods of treating, by 


Sick child, administration of 


baths. See Baths 


medicine to, advisabil- 


by change of climate, 79 


ity of doctor ^s pre- 


by diet, 52 


scription for, 46 


by douches, 70 


avoidance of patent medi- 


by dry cups, 64 


cines, 49 


by electricity, 79 


calomel, 48 


by enemata, 65 


castor oil, 47 


by hot fomentations or 


crushing of pills, tablets, 


stupes, 62 


capsules, 51 


by hot water bag, 61 



19 



278 



INDEX 



Sick child, methods of treating, 


Soothing syrups, caution 


hj ice cap, 60 


against, 205 


by inhalations, 74 


Sore throat, in children with 


by irrigation, of bowels, 66 


rheumatic tendency, 


of ear, 74 


160 


of eye, 73 


in diphtheria, 235 


by massage, 77 


in scarlet fever, 221 


by mustard paste, 63 


See Pharyngitis 


by packs. See Packs 


Soup, Keller's malt, recipe for 


by spraying of nose and 


29 


throat, 72 


Soups or purees, cream of cel- 


by stomach washing, 69 


ery and other vegeta- 


by suppositories, 69 


bles, recipe for, 31 


toilet of, 6, 7 


potato, recipe for, 31 




Speech, nervous disorders of, 


Sickroom, appurtenances of 


203 


feeding in, 12, 13 


causes of, 204 


choice and arrangement of, 1 


treatment of, 204 


disinfection of, 2 


Sponge baths, in German mea- 


feeding for. See Feeding 


sles, 233 


fumigation of. See Fumiga- 


in scarlet fever, 222 


tion 


in typhoid fever, 240 


furnishings of, 2 


Spraying of nose, in rhinitis. 


laundry from, 2 


acute, 168 


precautions in dress in, 2 


Spraying of nose and throat, 72, 


Skin, character and color of, 38 


73 


Skin irritations, bran bath for. 


in chronic catarrh, 170 


55 


Spraying of throat, for tonsil- 


soda bath for, 56 


litis, 172 


starch baths for, 57 


Sprays, throat, 172 


Sleeplessness or disturbed sleep, 


Sprue. See Thrush 


causes of, 204 


Stammering. See Speech, nerv- 


treatment of, 205 


ous disorders of 


Smallpox, period of incubation 


Stiff neck, in children with in- 


of, 213 


herited rheumatic ten- 


Soap suppositories, 69 


dency, 161 



INDEX 



279 



Stomach, diseases of, acidosis — 


Stools, hard, dry, constipated. 


recurrent or cyclic 


See Constipation 


vomiting, 112 


large, dry, clay-colored or 


gastritis, chronic, 106 


whitish, 116 


vomiting, or acute gastric 


loose, green, or yellowish- 


indigestion, 103 


green, having sour 


Stomach and intestines, acute 


odor, 116 


infections of, cholera 


thin, colorless, watery, or 


infantum, 124 


^'rice stools,'^ in chol- 


diarrhea, simple or summer. 


era infantum, 124 


117 


thin, watery, yellow or 


diseases of, bilious attacks, 


green, with or without 


140 


mucus and blood, 117 


colic, 133 


in marasmus, 156 


constipation, chronic, 130 


meconium, 114 


intestinal indigestion, 


normal amount of, 115 


chronic, 126 


normal character of, 114 


intestinal parasites or 


normal color of, 114, 115 


worms, 137 


other colors of, 117 


Stomach wash, for gastric indi- 


Strychnin, in treatment of enu- 


gestion, 104 


resis, 46 


for gastritis, chronic, 108 


Stupes, hot, 62 


Stomach washing, 69 


laudanum, 62 


Stomatitis, aphthous (canker 


turpentine, 62 


sores), symptoms and 


Stuttering. See Speech, nervous 


treatment of, 96 


disorders of 


causes of, 95 


Sugar, use of, in infant feed- 


simple or catarrhal, symptoms 


ing, 19 


and treatment of, 96 


' * Summer complaint. ^ ^ See 


ulcerative, causes of, 97 


Diarrhea, simple or 


formula for mouthwash for. 


summer 


98 


Sun baths, for chronic gastritis, 


symptoms of, 97 


108 


treatment of, 97 


Suppositories, gluten, 69 


Stools, abnormal, curds in, 115, 


glycerin, 69 


116 


medicated, 70 



280 



INDEX 



Suppositories, soap, 69 

use of, 69 
Sweat, in malaria, 242 
Swelling, of glands at back and 
sides of neck, in Ger- 
man measles, 232 
of joints, due to scarlet fever, 

223 
of lymphatic glands, simple, 
differentiated from 
mumps, 216 
of parotid glands, in mumps, 
213, 214, 216 
Syphilis, inherited, massage 
with mercurial oint- 
ment for, 78 
Syringe, fountain, for nasal 
douches, 71 
for vaginal douches, 70 
rectal, type of, for enemata, 
66 

Tapeworm. See Intestinal para- 
sites 
Teeth, injury to, by irons and 

acids, 51 
Teething, care not to tax diges- 
tion during, 95 
painful, symptoms of, 94 

treatment of, 94 
rhinitis, acute, due to, 165 
Temperature, high, due to hot 
water bag, 41 
normal, 41 
taking of, 40 
See also Fever 



Tenderness, in legs and joints, 

in scurvy, 144 
Threadworms. See Intestinal 

parasites 
Throat, diseases of, catarrh, 
chronic, adenoids and 
enlarged tonsils, 168 
tonsillitis, follicular, 171 
Throat and mouth douches, 72 
Throat and nose, spraying of, 

72, 73 
Thrush, causes of, 98 

precautions against, in ma- 
rasmus, 148 
prevention and treatment of, 

98 
symptoms of, 98 
Thumb- sucking, bad effects of, 
206 
treatment of, 206 
Toilet of sick child, 6, 7 
Toilet powder, formula for, 120 
Tongue, condition of, 38 
diseases of, red patches, 93 
ulcers, 93 
Tongue-sucking habit, 207 
Tonic effect of salt water baths, 

55 
Tonsillitis, follicular, causes of, 
171 
symptoms of, 171, 172 
treatment of, 172 
Tonsils, enlarged. See Enlarged 

tonsils 
Tuberculosis, of bones (Pott's 
disease), 245 



INDEX 



281 



Tuberculosis, of brain (tubercu- 


Urine, ' * brick dust ' ' deposit in. 


lar meningitis), 245 


cause and treatment 


causes of, 244 


of, 42, 43 


change of climate for, 79, 80 


condition of, in rheumatism, 


of glands of neck, 245 


159 


due to influenza, 249 


effect on, of fever, 41 


of joints, 245 


incontinence of. See Enure- 


symptoms of, 244, 245 


sis 


treatment of, 245, 246 


indican in, in intestinal indi- 


type of, resembling maras- 


gestion, 130 


mus, 245 


to induce passing of, 43 


Typhoid fever, causes of, 238 


odor of ammonia in, 43 


disinfection of, 240 


over-frequent passing of. 


occurrence of, 237 


due to threadworms, 


period of incubation of, 213 


139 


symptoms of, eruption, 238 


scanty and highly colored, in 


fever, 238 


acidosis, 113 


general, 238 


in pneumonia, 191 


nervous, 239 


specimen of, importance of 


treatment of, confinement, 


securing, 42 


239 


method of taking, 43 


diet, 240 




sponge baths, 240 


Vaccination, care of, 220 


typhoid serum, 240 


necessity for, 219 


; Widal serum test for, 239 


process of, 219, 220 




site and time for, 219 


Ulcers, little, in corneri or an- 


'* taking '' of, 220 


gles of mouth, treat- 


Vaccinia. See Vaccination 


ment for, 92 


Vaginal douches, 70 


of tongue, cause of, 93 


Varicella. See Chickenpox 


treatment of, 93 


Vomiting, in bilious attacks, 140 


Urine, appearance and amount 


causes of, 103 


of, 41 


chronic. See Gastritis, chron- 


average daily quantity of, in 


ic 


health, Holt's table 


in cholera infantum, 124 


for, 42 


after feeding, 104 



282 



INDEX 



Vomiting, induced by ipecac, in 
bronchitis, 183 
in croup, 174 
in onset of pneumonia, 190 
in onset of scarlet fever, 221 
due to overfeeding, 103 
recurrent or cyclic. See Aci- 
dosis 
severe, stomach washing for, 

69 
significance of eruption after 

attack of, 106 
symptoms of, 104 
treatment for, 104-106 
in whooping-cough, 229 

Water drinking, for children 
with inherited rheu- 
matic tendencies, 159 

Weighing, of premature in- 
fants, 90 

Whey, recipe for, 28 

Whooping- c o u g h, bronchitis 
with, 179 



Whooping-cough, bronchopneu- 
monia, developed from, 
186 
causes of, 227 
change of climate for, 79 
complications in, 229 
contagion of, 227 
disinfection of, 230 
period of incubation of, 212 
symptoms of, catarrhal stage, 
228 
cough, 228 
spasmodic stage, 228 
treatment of, 229 
abdominal belt, 230 
drugs, 230 
feeding, 229 
inhalations, 230 
patent medicines, 230 
Widal serum test for typhoid 

fever, 239 
Wine jelly, recipe for, 34 
Worms. See Intestinal para- 
sites 



jl 



